Therapeutic effects of glucocorticoids in patients with hematologic diseases with neutropenia and severe pneumonia classified by the PSI scores
10.3760/cma.j.cn121090-20240624-00234
- VernacularTitle:糖皮质激素在血液病患者粒细胞缺乏伴PSI评分中高危肺炎中的治疗效果
- Author:
Shufang XUE
1
;
Jinhua REN
;
Lijin CHEN
;
Xiaoqin ZHAO
;
Ting YANG
;
Jianda HU
Author Information
1. 福建医科大学附属协和医院血液科，福建省血液病重点实验室，福建省血液病研究所，福州 350001
- Publication Type:Journal Article
- Keywords:
Glucocorticoids;
Neutropenia;
Pneumonia severity index;
Severe pneumonia
- From:
Chinese Journal of Hematology
2024;45(11):1035-1042
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study aimed to investigate the clinical value of glucocorticoids in patients with neutropenic severe pneumonia at moderate to high risk according to the Pneumonia Severity Index (PSI) in patients with hematologic diseases.Methods:Clinical data were collected from 534 patients at the Fujian Medical University Union Hospital from October 2016 to December 2018. We evaluated the changes in inflammatory cytokines, treatment failure, in-hospital mortality, and other outcomes, adjusting for potential confounders through propensity score matching.Results:Patients were categorized into glucocorticoids ( n=176) and control ( n=358) groups. The glucocorticoid group demonstrated higher levels of C-reactive protein, procalcitonin, and interleukin-6, alongside higher PSI scores. The differences in comorbidities diminished, except for inflammatory cytokine levels, with a notable reduction in inflammatory cytokines observed in the glucocorticoid group, after matching 125 pairs based on propensity scores. Late treatment failure was more prevalent in the glucocorticoid group (39.2% vs 24.8%, P=0.015), but this was primarily caused by radiographic progression. The incidences of respiratory failure, mechanical ventilation, and septic shock were similar between the groups. Logistic regression analyses revealed that glucocorticoids reduced the risk of treatment failure ( OR=0.367, 95% CI 0.165-0.818, P=0.014). The 30-day in-hospital mortality rates were comparable (8.0% in glucocorticoids vs 7.2% in controls, P=0.811), with indications that glucocorticoids may exert a protective effect on mortality. The PSI score was determined as the sole independent risk factor for 30-day in-hospital mortality ( OR=1.077, 95% CI 1.032-1.123, P=0.001). No evidence indicated that glucocorticoids increased the incidence of hyperglycemia, gastrointestinal bleeding, or 30-day infection recurrence. Conclusion:Glucocorticoids reduce inflammatory cytokine levels and are potentially related to decreased treatment failure and mortality in patients with neutropenic pneumonia classified as PSI Ⅳ and Ⅴ among hematological patients.
