糖皮质激素在肺炎中的应用.docxVIP

糖皮质激素在肺炎中的应用 糖皮质激素在肺炎中的应用 Jenni LaidmanFebruary 18, 2021 Corticosteroids were associated with reduced treatment failure among people with severe community-acquiredpneumonia and excessive inflammatory response, a study published in the February 17 issue of JAMA reveals.Antoni Torres, MD, PhD, director, Clinical Institute of Pulmonology and Thoracic Surgery (Institut Clínic de Pneumonologia i Cirurgia Toràcica), Hospital Clinic, Barcelona, Spain, and colleagues randomly assigned 120patients with pneumonia and high inflammatory response to receive either a placebo (n = 59) or methylprednisolone (n = 61) for 5 days, beginning within 36 hours of admission. Patients in the double-blind trialalso received antibiotics. The researchers defined high inflammatory response as C-reactive protein levels greaterthan 150 mg/L. Treatment failure was the primary trial outcome. In-hospital mortality was a secondary outcome.Treatment failed for eight (13%) of the patients in the methylprednisolone group and 18 (31%) in the placebo group(P = .02), for an 18% difference between the groups (95% confidence interval [CI], 3% - 32%). Corticosteroidsreduced the risk for treatment failure by 66% (odds ratio, 0.34; 95% CI, 0.14 - 0.87; P = .02). In-hospital mortalitydid not differ significantly between the two groups (P = .37), nor did levels of hyperglycemia (P = .34). Treatment failure included shock, need for invasive mechanical ventilation, and death within 72 hours of treatment.The authors report a reduction in late treatment failure with steroid therapy, principally as a result of decreased radiographic progression and late septic shock, both of which have been associated with higher mortality in severecommunity-acquired pneumonia. Richard G. Wunderink, MD, from Northwestern University Feinberg School of Medicine, Chicago, Illinois, writes inan accompanying editorial that baseline imbalances between the two trial groups may explain a portion of theresponse,