Real-world use of glucocorticoids and clinical outcomes in adults hospitalized with community-acquired pneumonia on medical wards.

Autor: Malecki S; Internal Medicine Residency Program, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada., Loffler A; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada., Liao F; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada., Hora T; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada., Agarwal A; Internal Medicine Residency Program, University of Toronto, Toronto, Ontario, Canada., Lail S; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada., Roberts SB; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada., McFadden D; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Gupta S; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada., Razak F; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Canada., Verma AA; Internal Medicine Residency Program, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Canada.; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
Jazyk: angličtina
Zdroj: Journal of hospital medicine [J Hosp Med] 2024 Jun 02. Date of Electronic Publication: 2024 Jun 02.
DOI: 10.1002/jhm.13422
Abstrakt: Background: Little is known about the real-world use of systemic glucocorticoids to treat patients hospitalized with community-acquired pneumonia (CAP) outside of the intensive care unit (ICU).
Methods: This retrospective cohort study included 11,588 hospitalizations for CAP without chronic pulmonary disease at seven hospitals in Ontario, Canada. We report physician-level variation in the use of glucocorticoids and trends over time. We investigated the association between glucocorticoid prescriptions and clinical outcomes, using propensity score overlap weighting to account for confounding by indication.
Results: Glucocorticoids were prescribed in 1283 (11.1%) patients, increasing over time from 10.0% in 2010 to 11.9% in 2020 (p = .008). Physician glucocorticoid prescribing ranged from 2.9% to 34.6% (median 10.0%, inter quartile range [IQR]: 6.7%-14.6%). Patients receiving glucocorticoids tended to be younger (median age 73 vs. 79), have higher Charlson comorbidity scores (score of 2 or more: 42.4% vs. 31.0%), more cancer (26.6% vs. 13.2%), more renal disease (11.5% vs. 6.6%), and less dementia (7.8% vs. 14.8%). Patients treated with glucocorticoids had higher rates of in-hospital mortality (weighted Risk Difference = 1.72, 95% confidence interval [95% CI]: 0.16-3.3, p = .033). Glucocorticoid use was not associated with ICU admission, hospital length-of-stay, or 30-day readmission.
Conclusion: Glucocorticoids were prescribed in 11.1% of patients hospitalized with CAP outside of ICU and one in four physicians prescribed glucocorticoids in more than 14% of patients. Glucocorticoid use was associated with greater in-hospital mortality, although these findings are limited by large selection effects. Clinicians should exercise caution in prescribing glucocorticoids for nonsevere CAP, and definitive trials are needed in this population.
(© 2024 The Author(s). Journal of Hospital Medicine published by Wiley Periodicals LLC on behalf of Society of Hospital Medicine.)
Databáze: MEDLINE
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