Aetiology and prognostic risk factors of mortality in patients with pneumonia receiving glucocorticoids alone or glucocorticoids and other immunosuppressants: a retrospective cohort study

• Published in: BMJ open 2020-10, Vol.10 (10), p.e037419-e037419
• Main Authors: Li, Lijuan, Hsu, Steven H, Gu, Xiaoying, Jiang, Shan, Shang, Lianhan, Sun, Guolei, Sun, Lingxiao, Zhang, Li, Wang, Chuan, Ren, Yali, Wang, Jinxiang, Pan, Jianliang, Liu, Jiangbo, Bin, Cao
• Format: Article
• Language: English
• Subjects: adult intensive & critical care; Antibiotics; China - epidemiology; Cohort analysis; Connective tissue diseases; Cytomegalovirus; diagnostic microbiology; Drug dosages; Etiology; Glucocorticoids - adverse effects; Humans; Immunosuppressive agents; Immunosuppressive Agents - adverse effects; Infectious Diseases; Laboratories; Lavage; Lung diseases; Medical diagnosis; Medical prognosis; microbiology; Mortality; Nosocomial infections; Pathogens; Patients; Pneumocystis carinii; Pneumonia; Pneumonia, Pneumocystis; Prognosis; Respiratory failure; respiratory infections; Retrospective Studies; Risk Factors; Sepsis; Staphylococcus infections; Ventilators; Viral infections
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-037419

ObjectivesLong-term use of high-dose glucocorticoids can lead to severe immunosuppression and increased risk of treatment-resistant pneumonia and mortality. We investigated the aetiology and prognostic risk factors of mortality in hospitalised patients who developed pneumonia while receiving glucocorticoid therapy alone or glucocorticoid and other immunosuppressant therapies.DesignRetrospective cohort study.SettingSix secondary and tertiary academic hospitals in China.ParticipantsPatients receiving glucocorticoids who were hospitalised with pneumonia between 1 January 2013 and 31 December 2019.Main outcomesWe analysed the prevalence of comorbidities, microbiology, antibiotic susceptibility patterns, 30-day and 90-day mortality and prognostic risk factors.ResultsConclusionsA total of 716 patients were included, with pneumonia pathogens identified in 69.8% of patients. Significant morbidities occurred, including respiratory failure (50.8%), intensive care unit transfer (40.8%) and mechanical ventilation (36%), with a 90-day mortality of 26.0%. Diagnosis of pneumonia occurred within 6 months of glucocorticoid initiation for 69.7% of patients with Cytomegalovirus (CMV) pneumonia and 79.0% of patients with Pneumocystis jirovecii pneumonia (PCP). Pathogens, including Pneumocystis, CMV and multidrug-resistant bacteria, were identified more frequently in patients with persistent lymphocytopenia and high-dose glucocorticoid treatment (≥30 mg/day of prednisolone or equivalent within 30 days before admission). The 90-day mortality was significantly lower for non-CMV viral pneumonias than for PCP (p