Comparative Dosing of Adjunctive Corticosteroids Therapy for Pneumocystis Pneumonia with ARDS in Non-HIV Immunocompromised Patients

作者：Xuyan Li, Lujia Guan, Dong Wang, Xiao Tang, Rui Wang, Ying Li, Zhaohui Tong, Bing Sun, Chen Wang · 发表于：Infection and Drug Resistance · 年份：2024 · DOI：10.2147/idr.s493298 · 被引用次数：5 · 研究领域：Pneumocystis jirovecii pneumonia detection and treatment、Respiratory viral infections research、Drug-Induced Adverse Reactions

Background: Adjuvant corticosteroids are effective in patients with human immunodeficiency virus (HIV)-associated Pneumocystis jirovecii pneumonia (PCP) patients, but the effectiveness of adjuvant corticosteroids in non-HIV PCP remained controversial. This study aimed to evaluate the effectiveness of standard-dose compared with low-dose steroids in non-HIV PCP patients with acute respiratory distress syndrome (ARDS). Methods: This retrospective observational study included non-HIV PCP patients with ARDS admitted to the respiratory intensive care unit (RICU) of Beijing Chao-Yang Hospital from 2015 to 2022. Demographics, clinical characteristics, and outcomes were compared between patients receiving standard-dose and those receiving low-dose steroids. Survival times were assessed using Kaplan-Meier curves and compared with the Log rank test. Cox proportional hazards regression analysis was conducted to identify independent risk factors for 28-day and 60-day mortality. Results: A total of 105 non-HIV PCP with ARDS were included, with 48 patients in the standard-dose steroid group (66.7% male, 50.5± 12.6 years) and 57 in the low-dose steroid group (61.4% male, 55.5± 14.2 years). The 60-day mortality was lower in the standard-dose group than in the low-dose group (63.2% vs 48.3%, p=0.04), while 28-day mortality showed no significant difference (50.8% vs 35.4%, p=0.11). After adjusting for confounders, standard-dose steroids reduced 28-day mortality (aHR: 0.339, 95% CI: 0.147– 0.78...