Patrick M Wieruszewski1,2, Erin F Barreto1,2,3, Jason N Barreto1, Hemang Yadav2,4, Pritish K Tosh5, Kristin C Mara6, Andrew H Limper3,4,7,8. 1. Department of Pharmacy, 4352Mayo Clinic, Rochester, MN, USA. 2. Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), 4352Mayo Clinic, Rochester, MN, USA. 3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 4352Mayo Clinic, Rochester, MN, USA. 4. Division of Pulmonary and Critical Care Medicine, 4352Mayo Clinic, Rochester, MN, USA. 5. Division of Infectious Diseases, 4352Mayo Clinic, Rochester, MN, USA. 6. Division of Biomedical Statistics and Informatics, 4352Mayo Clinic, Rochester, MN, USA. 7. Department of Biochemistry and Molecular Biology, 4352Mayo Clinic, Rochester, MN, USA. 8. Thoracic Diseases Research Unit, 4352Mayo Clinic, Rochester, MN, USA.
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.
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.
Authors: Zachary Hoy; Terry W Wright; Michael Elliott; Jane Malone; Samir Bhagwat; Jing Wang; Francis Gigliotti Journal: Infect Immun Date: 2020-01-22 Impact factor: 3.441