<p>Effectiveness of Steroid Therapy on Pneumonic Chronic Obstructive Pulmonary Disease Exacerbation: A Multicenter, Retrospective Cohort Study</p>

Abstract

To date, no consensus exists on the effects of systemic steroid use on pneumonic chronic obstructive pulmonary disease (COPD) exacerbation owing to trial design issues in previous trials involving these conditions. This multicenter study aimed to evaluate more precisely the effectiveness of the use of systemic steroids in treating pneumonic COPD exacerbation in a larger sample by adjusting for confounding factors. Patients and Methods: This multicenter, retrospective, observational study was conducted across five acute general hospitals in Japan. We analyzed the association between parenteral/ oral steroid therapy and time to clinical stability in pneumonic COPD exacerbation. We used a validated algorithm derived from the 10th revision of the International Classification of Diseases and Related Health Problems (ICD-10) to include patients with pneumonic COPD exacerbation. We excluded patients with other hypoxia causes (asthma exacerbation, pneumothorax, heart failure) and complicated pneumonia (obstructive pneumonia, empyema), those who required tracheal intubation/vasopressors, and those who were clinically stable on day of admission. The primary outcome was the time to clinical stability. Multiple imputation was used for missing data. Propensity scores within each imputed dataset were calculated using potential confounding factors. The Fine and Gray model was used within each dataset to account for the competing risk of death and hospital discharge without clinical stability, and we combined the results. Results: Altogether, 1237 patients were included. Systemic steroid therapy was administered to 658 patients (53%). The pooled estimated subdistribution hazard ratio of time to clinical stability in steroid vs non-steroid users was 0.89 (95% confidence interval, 0.78 to 1.0). Conclusion: This study revealed that systemic steroid therapy may not improve the time to clinical stability in patients with pneumonic COPD exacerbation of mild to moderate severity. Further randomized controlled trials including more severe patients will be needed to evaluate the effectiveness of systemic steroid therapy accurately.

The prognostic factors of in-hospital death among patients with pneumonic COPD acute exacerbation

“…25 However, in daily practice, pulmonary function test results might be missing, especially from the patients' rst visit. 17 Our study selected easily accessible variables that physicians can use in various clinical settings. Second, in our dataset, the eosinophil count was missing in 44.7% of cases.…”

“…To select the patients with pneumonic COPD-AE, we used a validated selection algorithm based on the 10th revision of the International Statistical Classi cation of Diseases and Related Health Problems (ICD-10) in another study. 17 Speci cally, we used the following criteria: (1) the admission precipitating the diagnosis of pneumonia (ICD-10 codes: J12, J13, J14, J15, J16, J18, J69, and P23) with comorbidity of COPD or COPD-AE (ICD-10 codes: J44.1 and J44.9) and ( 2) the admission precipitating diagnosis of COPD exacerbation (ICD-10 code; J44.1) with comorbidity of pneumonia (ICD-10 codes: J12, J13, J14, J15, J18, J69, and P23). We excluded the following other causes of respiratory failure: heart failure (ICD-10 code; I50), pneumothorax (ICD-10 code: J93), asthma exacerbation (ICD-10 code: J45), obstructive pneumonia (ICD-10 code: J188).…”

Predicting in-hospital death in pneumonic COPD exacerbation via BAP-65, CURB-65 and machine learning

“…Pneumonic COPD exacerbation is diagnosed when the criteria for both pneumonia and COPD exacerbation are met [ 4 , 12 , 13 ]. To select patients with pneumonic COPD exacerbation, we used the validated algorithm based on the 10th revision of the International Classification of Diseases and Related Health Problems (supplementary eFigure S1 ) [ 4 ]. First, patients aged ≥40 years who had both pneumonia and COPD exacerbation were selected.…”

“…Patients with COPD often experience acute worsening of baseline symptoms, and with coexisting consolidation (pneumonic COPD exacerbation) on chest imaging, mortality is increased compared to non-pneumonic COPD exacerbation [ 2 ]. A previous study suggested that pneumonic COPD exacerbation might have a different inflammation profile from non-pneumonic COPD exacerbation [ 3 , 4 ].…”

Predicting In-hospital Death in Pneumonic COPD exacerbation via BAP-65, CURB-65, and Machine Learning

“…Patient selection was based on a validated algorithm for selecting patients with pneumonic COPD exacerbation [9]. The algorithm was based on the 10th revision of the International Classi cation of Diseases and Related Health Problems.…”