背景:COPD加重是发病率和死亡率的主要原因。虽然吸入性皮质类固醇(ICS)具有长期治疗作用,它们在恶化中的功效,特别是作为全身性类固醇的辅助药物,尚不清楚。
方法:在这项回顾性观察研究中,我们分析了2018年1月至2023年1月在以色列三级医疗中心接受COPD加重治疗的870名受试者的数据.我们调查了在标准全身性类固醇治疗中添加ICS对住院时间的影响,插管率,和30天死亡率,使用倾向得分匹配来解释混杂因素。
结果:队列,匹配后,包括354名接受全身性类固醇和ICS治疗的受试者和121名单独接受全身性类固醇治疗的受试者。两组之间的所有特征相似。我们的分析显示30天死亡率没有差异(7.1%vs5.8%,P=0.63)或次要结果(插管,住院时间,和再入院率)。基于不同嗜酸性粒细胞水平的亚组分析没有改变这些发现。在一般队列的多变量分析中,嗜酸性粒细胞计数<150个细胞/μL(调整比值比0.45[95%CI0.21-0.87],P=.02)和高Charlson得分(调整后的赔率比1.19[95%CI1.02-1.37],P=.02)是30天死亡率的独立预测因子。
结论:尽管已知ICS治疗慢性COPD的益处,我们没有发现ICS对加重期全身性类固醇的附加价值.这些结果强调了个体化治疗策略和进一步研究ICS在COPD加重中的作用的必要性。
BACKGROUND: COPD exacerbations are a major cause of morbidity and mortality. Although inhaled corticosteroids (ICS) have a role as long-term treatment, their efficacy in exacerbations, particularly as an adjunct to systemic steroids, remains unclear.
METHODS: In this retrospective observational study, we analyzed data from 870 subjects admitted with COPD exacerbations to a tertiary medical center in Israel from January 2018-January 2023. We investigated the impact of adding ICS to standard systemic steroid treatment on hospital length of stay, intubation rates, and 30-d mortality using propensity score matching to account for confounders.
RESULTS: The cohort, after matching, included 354 subjects treated with systemic steroids and ICS and 121 treated with systemic steroids alone. All characteristics were similar between the groups. Our analysis showed no differences in 30-d mortality (7.1% vs 5.8%, P = .63) or secondary outcomes (intubation, hospital length of stay, and readmission rates) between the groups. Subgroup analyses based on different eosinophil levels did not alter these findings. In multivariate analysis among the general cohort, eosinophil count < 150 cells/μL (adjusted odds ratio 0.45 [95% CI 0.21-0.87], P = .02) and high Charlson score (adjusted odds ratio 1.19 [95% CI 1.02-1.37], P = .02) were independent predictors for 30-d mortality.
CONCLUSIONS: Despite the known benefits of ICS in managing chronic COPD, we did not find an added value of ICS to systemic steroids in exacerbations. These results underscore the necessity for individualized treatment strategies and further research into the role of ICS in COPD exacerbations.