PURPOSE:Recent clinical studies suggest that use of inhaled corticosteroid (ICS) in COPD may increase the likelihood of developing community acquired pneumonia (CAP). However, it is unclear if CAP patients on ICS will have worse outcomes, compared to those that are not on ICS. Therefore, our aim was to assess the impact of prior outpatient ICS therapy on hospitalized CAP patients in the development of severe sepsis, severe CAP and 30-day mortality.
METHODS:A retrospective, observational study was conducted at two tertiary teaching hospitals. Eligible patients were admitted with a diagnosis of pneumonia between 1/1/1999 and 12/31/2001. All patients had a chest x-ray consistent with pneumonia, and had a discharge ICD-9 diagnosis of pneumonia. Patients were asses for severity using the revisited American Thoracic Society (rATS) for severe CAP and clinical criteria of severe sepsis [ACCP consensus]. Our primary analyses were logistic regression models including a propensity score for ICS, receipt of ICS, and dependent variables of severe sepsis, severe pneumonia, or 30-day mortality.
RESULTS:Data was abstracted for 712 subjects with a diagnosis of CAP, 89 (13.4%) were on ICS. All cause mortality was 9.4% at 30-days, but there were not significant differences between groups (ICS [7.9%] vs. no-ICS [9.6%], p=0.6). In the regression analysis, outpatient ICS therapy was associated with less severe disease for those patients presenting with severe sepsis (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.22–0.70), and severe CAP (OR 0.51, 95% CI 0.25–1.05) and 30-day mortality (OR 0.51, 95% CI 0.22–1.19). The Kaplan Meier Curve shows a trend towards survival among those patients that received ICS therapy compared no-ICS therapy.
CONCLUSION:Outpatient therapy with ICS was associated with less severe disease and no significant difference in mortality.
CLINICAL IMPLICATIONS:Prospective studies are needed to evaluate if ICS patients are at increased risk of death as compared to non-ICS.
DISCLOSURE:Rosa Malo de Molina, None.