Early Corticosteroids for Pneumocystis Pneumonia in Adults Without HIV Are Not Associated With Better Outcome

Patrick M. Wieruszewski, Jason N. Barreto, Erin Frazee, Craig E. Daniels, Pritish K. Tosh, Ross A. Dierkhising, Kristin C. Mara, Andrew Harold Limper

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Evidence supporting adjunctive corticosteroids during the treatment of Pneumocystis jirovecii pneumonia (PcP) in adults without HIV is minimal and controversial. Methods: This retrospective cohort study included P jirovecii pneumonia-positive, hospitalized patients without HIV admitted to the Mayo Clinic from 2006 to 2016. Change from baseline in the respiratory component of the Sequential Organ Failure Assessment score (SOFAresp) at day 5 was compared between early (within 48 h) steroid recipients and nonrecipients by using multivariable logistic regression and in a propensity-matched analysis. Results: Among the 323 included patients (early steroids, n = 258; no steroids, n = 65), the median (interquartile range) age was 65 (53, 73) years, 63% were male, and 92% were white. Severity-adjusted regression and propensity-matched analyses found that early administration of steroids was associated with less improvement in SOFAresp at day 5 compared with no steroids (P = .001 and P = .017, respectively). No differences were observed in the odds of having at least a one-point improvement in SOFAresp at day 5 compared with baseline between groups (adjusted OR, 0.76 [95% CI, 0.24-2.28]; P = .61). Overall 30-day mortality was 22.9% (95% CI, 18.2-27.4). No differences in mortality, length of stay, admission to the ICU, or need for mechanical ventilation were found between early steroid recipients and nonrecipients. Conclusions: The addition of early corticosteroids to anti-Pneumocystis therapy in patients without HIV was not associated with improved respiratory outcomes.

Original languageEnglish (US)
JournalChest
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Pneumocystis Pneumonia
Adrenal Cortex Hormones
Steroids
HIV
Pneumocystis
Organ Dysfunction Scores
Pneumocystis carinii
Mortality
Artificial Respiration
Length of Stay
Pneumonia
Cohort Studies
Retrospective Studies
Logistic Models
Therapeutics

Keywords

  • immunocompromised host
  • pneumocystis
  • respiratory failure
  • steroids

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Wieruszewski, P. M., Barreto, J. N., Frazee, E., Daniels, C. E., Tosh, P. K., Dierkhising, R. A., ... Limper, A. H. (Accepted/In press). Early Corticosteroids for Pneumocystis Pneumonia in Adults Without HIV Are Not Associated With Better Outcome. Chest. https://doi.org/10.1016/j.chest.2018.04.026

Early Corticosteroids for Pneumocystis Pneumonia in Adults Without HIV Are Not Associated With Better Outcome. / Wieruszewski, Patrick M.; Barreto, Jason N.; Frazee, Erin; Daniels, Craig E.; Tosh, Pritish K.; Dierkhising, Ross A.; Mara, Kristin C.; Limper, Andrew Harold.

In: Chest, 01.01.2018.

Research output: Contribution to journalArticle

Wieruszewski, Patrick M. ; Barreto, Jason N. ; Frazee, Erin ; Daniels, Craig E. ; Tosh, Pritish K. ; Dierkhising, Ross A. ; Mara, Kristin C. ; Limper, Andrew Harold. / Early Corticosteroids for Pneumocystis Pneumonia in Adults Without HIV Are Not Associated With Better Outcome. In: Chest. 2018.
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abstract = "Background: Evidence supporting adjunctive corticosteroids during the treatment of Pneumocystis jirovecii pneumonia (PcP) in adults without HIV is minimal and controversial. Methods: This retrospective cohort study included P jirovecii pneumonia-positive, hospitalized patients without HIV admitted to the Mayo Clinic from 2006 to 2016. Change from baseline in the respiratory component of the Sequential Organ Failure Assessment score (SOFAresp) at day 5 was compared between early (within 48 h) steroid recipients and nonrecipients by using multivariable logistic regression and in a propensity-matched analysis. Results: Among the 323 included patients (early steroids, n = 258; no steroids, n = 65), the median (interquartile range) age was 65 (53, 73) years, 63{\%} were male, and 92{\%} were white. Severity-adjusted regression and propensity-matched analyses found that early administration of steroids was associated with less improvement in SOFAresp at day 5 compared with no steroids (P = .001 and P = .017, respectively). No differences were observed in the odds of having at least a one-point improvement in SOFAresp at day 5 compared with baseline between groups (adjusted OR, 0.76 [95{\%} CI, 0.24-2.28]; P = .61). Overall 30-day mortality was 22.9{\%} (95{\%} CI, 18.2-27.4). No differences in mortality, length of stay, admission to the ICU, or need for mechanical ventilation were found between early steroid recipients and nonrecipients. Conclusions: The addition of early corticosteroids to anti-Pneumocystis therapy in patients without HIV was not associated with improved respiratory outcomes.",
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AB - Background: Evidence supporting adjunctive corticosteroids during the treatment of Pneumocystis jirovecii pneumonia (PcP) in adults without HIV is minimal and controversial. Methods: This retrospective cohort study included P jirovecii pneumonia-positive, hospitalized patients without HIV admitted to the Mayo Clinic from 2006 to 2016. Change from baseline in the respiratory component of the Sequential Organ Failure Assessment score (SOFAresp) at day 5 was compared between early (within 48 h) steroid recipients and nonrecipients by using multivariable logistic regression and in a propensity-matched analysis. Results: Among the 323 included patients (early steroids, n = 258; no steroids, n = 65), the median (interquartile range) age was 65 (53, 73) years, 63% were male, and 92% were white. Severity-adjusted regression and propensity-matched analyses found that early administration of steroids was associated with less improvement in SOFAresp at day 5 compared with no steroids (P = .001 and P = .017, respectively). No differences were observed in the odds of having at least a one-point improvement in SOFAresp at day 5 compared with baseline between groups (adjusted OR, 0.76 [95% CI, 0.24-2.28]; P = .61). Overall 30-day mortality was 22.9% (95% CI, 18.2-27.4). No differences in mortality, length of stay, admission to the ICU, or need for mechanical ventilation were found between early steroid recipients and nonrecipients. Conclusions: The addition of early corticosteroids to anti-Pneumocystis therapy in patients without HIV was not associated with improved respiratory outcomes.

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