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Adjunct corticosteroids in children hospitalized with community-acquired pneumonia
Anna K Weiss1, Matthew Hall, Grace E Lee
1Division of Infectious Diseases, Children's Hospital of Philadelphia, Room 1526, North Campus, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Insights
Systemic corticosteroids shortened hospital stays for children with community-acquired pneumonia (CAP) who also received beta-agonist therapy. However, for CAP patients without beta-agonist treatment, corticosteroids increased length of stay and readmission risk.
Area of Science:
- Pediatric Medicine
- Pulmonology
- Pharmacology
Background:
- Community-acquired pneumonia (CAP) is a common childhood illness requiring hospitalization.
- The role of systemic corticosteroid therapy in managing pediatric CAP remains debated.
- Understanding treatment efficacy is crucial for optimizing patient outcomes.
Purpose of the Study:
- To investigate the association between systemic corticosteroid therapy and outcomes in hospitalized children with CAP.
- To evaluate the impact of corticosteroids on length of stay, readmission rates, and hospitalization costs.
- To determine if outcomes differ based on concomitant use of beta-agonist therapy.
Main Methods:
- Multicenter, retrospective cohort study involving 20,703 children (aged 1-18 years) with CAP.
- Data analyzed from 36 children's hospitals.
- Multivariable regression and propensity score analysis adjusted for confounders to assess the primary exposure: adjunct systemic corticosteroids.
Main Results:
- Systemic corticosteroid use was associated with a shorter length of stay (LOS) overall.
- In children receiving beta-agonist therapy, corticosteroids correlated with a shorter LOS (aHR: 1.36).
- In children not receiving beta-agonists, corticosteroids were linked to a longer LOS (aHR: 0.85) and increased readmission risk (aOR: 1.97).
Conclusions:
- Adjunct systemic corticosteroids shortened LOS in pediatric CAP patients who also received beta-agonist therapy.
- For CAP patients not on beta-agonists, corticosteroids were associated with longer LOS and higher readmission rates.
- Findings suggest corticosteroids benefit only pediatric CAP patients with acute wheezing, potentially indicated by beta-agonist use.
Objective:
To determine if systemic corticosteroid therapy is associated with improved outcomes for children hospitalized with community-acquired pneumonia (CAP).
Methods:
In this multicenter, retrospective cohort study we used data from 36 children's hospitals for children aged 1 to 18 years with CAP. Main outcome measures were length of stay (LOS), readmission, and total hospitalization cost. The primary exposure was the use of adjunct systemic corticosteroids. Multivariable regression models and propensity scores were used to adjust for confounders.
Results:
The 20 703 patients whose data were included had a median age of 4 years. Adjunct corticosteroid therapy was administered to 7234 patients (35%). The median LOS was 3 days, and 245 patients (1.2%) required readmission. Systemic corticosteroid therapy was associated with shorter LOS overall (adjusted hazard ratio [HR]: 1.24 [95% confidence interval (CI): 1.18-1.30]). Among children who received treatment with β-agonists, the LOS was shorter for children who had received corticosteroids compared with children who had not (adjusted HR: 1.36 [95% CI: 1.28-1.45]). Among children who did not receive β-agonists, the LOS was longer for those who received corticosteroids compared with those who did not (adjusted HR: 0.85 [95% CI: 0.75-0.96]). Corticosteroids were associated with readmission of patients who did not receive concomitant β-agonist therapy (adjusted odds ratio: 1.97 [95% CI: 1.09-3.57]).
Conclusions:
For children hospitalized with CAP, adjunct corticosteroids were associated with a shorter hospital LOS among patients who received concomitant β-agonist therapy. Among patients who did not receive this therapy, systemic corticosteroids were associated with a longer LOS and a greater odds of readmission. If β-agonist therapy is considered a proxy for wheezing, our findings suggest that among patients admitted to the hospital with a diagnosis of CAP, only those with acute wheezing benefit from adjunct systemic corticosteroid therapy.
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