Preadmission Corticosteroid Therapy and the Risk of Respiratory Failure in Adults Without HIV Presenting With Pneumocystis Pneumonia

Patrick M. Wieruszewski, Erin F. Barreto, Jason N. Barreto, Hemang Yadav, Pritish K. Tosh, Kristin C. Mara, Andrew Harold Limper

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: Corticosteroid therapy is a well-recognized risk factor for Pneumocystis pneumonia (PCP); however, it has also been proposed as an adjunct to decrease inflammation and respiratory failure. Objective: To determine the association between preadmission corticosteroid use and risk of moderate-to-severe respiratory failure at the time of PCP presentation. Methods: This retrospective cohort study evaluated HIV-negative immunosuppressed adults diagnosed with PCP at Mayo Clinic from 2006 to 2016. Multivariable regression models were used to evaluate the association between preadmission corticosteroid exposure and moderate-to-severe respiratory failure at presentation. Results: Of the 323 patients included, 174 (54%) used preadmission corticosteroids with a median daily dosage of 20 (interquartile range: 10-40) mg of prednisone or equivalent. After adjustment for baseline demographics, preadmission corticosteroid therapy did not decrease respiratory failure at the time of PCP presentation (odds ratio: 1.23, 95% confidence interval: 0.73-2.09, P =.38). Additionally, after adjusting for inpatient corticosteroid administration, preadmission corticosteroid use did not impact the need for intensive care unit admission (P =.98), mechanical ventilation (P =.92), or 30-day mortality (P =.11). Conclusions: Corticosteroid exposure before PCP presentation in immunosuppressed HIV-negative adults was not associated with a reduced risk of moderate-to-severe respiratory failure.

Original languageEnglish (US)
JournalJournal of Intensive Care Medicine
DOIs
StatePublished - Jan 1 2019

Keywords

  • immunosuppression
  • PCP
  • PJP
  • pneumocystis
  • respiratory failure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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