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Adjuvant Corticosteroid Treatment in Adults With Influenza A (H7N9) Viral Pneumonia
Bin Cao1, Hainv Gao, Boping Zhou
11Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China. 2State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China. 3Shenzhen Third People's Hospital, Shenzhen City, Guangdong Province, China. 4Guangzhou No. 8 People's Hospital, Guangzhou City, Guangdong Province, China. 5Xiangya Hospital, Central South University, Changsha City, Hunan Province, China. 6First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China. 7Shanghai Public Health Clinical Center, Fudan University, Shanghai, China. 8The First Affiliated Hospital, Wenzhou Medical College, Wenzhou City, Zhejiang Province, China. 9The First Affiliated Hospital, Medical College of Soochow University, Suzhou, Jiangsu Province, China. 10Beijing Ditan Hospital, Capital Medical University, Beijing, China. 11Global Health, Population and Nutrition, Global Research and Services, Family Health International 360, Durham, NC. 12Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical school, Nanjing University, Nanjing City, Jiangsu Province, China. 13Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing City, Jiangsu Province, China. 14The Second Affiliated Hospital of the Southeast University, Nanjing City, Jiangsu Province, China. 15Yantai Yu Huang-Ding Hospital, Yantai City, Shandong Province, China. 16Affiliated Hospital of Zunyi Medical College, Zunyi City, Guizhou Province, China. 17Zaozhuang Municipal Hospital, Zaozhuang City, Shandong Province, China. 18Global Health, Population & Nutrition, Family Health International 360, Duke University, Durham, NC. 19China-Japan Friendship Hospital, Beijing, China.
Objective:
To determine the impact of adjuvant corticosteroids administered to patients hospitalized with influenza A (H7N9) viral pneumonia.
Design:
The effects of adjuvant corticosteroids on mortality were assessed using multivariate Cox regression and a propensity score-matched case-control study. Nosocomial infections and viral shedding were also compared.
Setting:
Hospitals with influenza A (H7N9) viral pneumonia patient admission in 84 cities and 16 provinces of Mainland China.
Patients:
Adolescent and Adult patients aged >14 yr with severe laboratory-confirmed influenza A (H7N9) virus infections were screened from April 2013 to March 2015.
Interventions:
None.
Measurements And Main Results:
The study population comprised 288 cases who were hospitalized with influenza A (H7N9) viral pneumonia. The median age of the study population was 58 years, 69.8% of the cohort comprised male patients, and 51.4% had at least one type of underlying diseases. The in-hospital mortality was 31.9%. Two hundred and four patients (70.8%) received adjuvant corticosteroids; among them, 193 had hypoxemia and lung infiltrates, 11 had chronic obstructive pulmonary disease, and 11 had pneumonia only. Corticosteroids were initiated within 7 days (interquartile range, 5.0-9.4 d) of the onset of illness and the maximum dose administered was equivalent to 80-mg methylprednisolone (interquartile range, 40-120 mg). The patients were treated with corticosteroids for a median duration of 7 days (interquartile range, 4.0-11.3 d). Cox regression analysis showed that compared with the patients who did not receive corticosteroid, those who received corticosteroid had a significantly higher 60-day mortality (adjusted hazards ratio, 1.98; 95% CI, 1.03-3.79; p = 0.04). Subgroup analysis showed that high-dose corticosteroid therapy (> 150 mg/d methylprednisolone or equivalent) significantly increased both 30-day and 60-day mortality, whereas no significant impact was observed for low-to-moderate doses of corticosteroids (25-150 mg/d methylprednisolone or equivalent). The propensity score-matched case-control analysis showed that the median viral shedding time was much longer in the group that received high-dose corticosteroids (15 d), compared with patients who did not receive corticosteroids (13 d; p = 0.039).
Conclusions:
High-dose corticosteroids were associated with increased mortality and longer viral shedding in patients with influenza A (H7N9) viral pneumonia.
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