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Early corticosteroids for Pneumocystis pneumonia in adults without HIV are not associated with better outcome.
Chest. 2018 Apr 26;:
Authors: Wieruszewski PM, Barreto JN, Frazee E, Daniels CE, Tosh PK, Dierkhising RA, Mara KC, Limper AH
Abstract
BACKGROUND: Evidence supporting adjunctive corticosteroids during the treatment of Pneumocystis pneumonia (PcP) in adults without human immunodeficiency virus (HIV) is minimal and controversial.
METHODS: This retrospective cohort study included PcP-positive, hospitalized patients without HIV admitted to 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 hours) steroid recipients and non-recipients utilizing 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 (IQR) age was 65 (53, 73) years, 63% were male, and 92% were Caucasian. Severity-adjusted regression and propensity-matched analyses demonstrated early steroids were associated with less improvement in SOFAresp at day 5 compared to no steroids, p = 0.001 and p = 0.017, respectively. No differences were observed in the odds of having a ≥ one-point improvement in SOFAresp at day 5 compared to baseline between groups (adjusted OR 0.76, 95% CI 0.24, 2.28; p = 0.61). 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 non-recipients.
CONCLUSIONS: The addition of early corticosteroids to anti-Pneumocystis therapy in patients without HIV was not associated with improved respiratory outcomes.
PMID: 29705221 [PubMed - as supplied by publisher]