单位：[1]Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China北京朝阳医院[2]State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, CollaborativeInnovation Center for Diagnosis and Treatment of Infectious Diseases, the FirstAffiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China浙江大学医学院附属第一医院[3]Global Health, Population & Nutrition, Global Research & Services, Family HealthInternational 360, Durham, NC, USA[4]Department of Respiratory Medicine, Second Hospital of Hebei Medical University,Shijiazhuang 050003, China[5]West China Hospital of Sichuan University, Chengdu 610041, China四川大学华西医院[6]The First Affiliated Hospital, Nanchang University, Nanchang 330019, China[7]Shengjing Hospital of China Medical University, Shenyang 1 10004, China中国医科大学附属盛京医院[8]The Second Affiliated Hospital of Harbin Medical University, Harbin 150080, China[9]Renmin Hospital of Wuhan University, Wuhan 430060, China[10]Fujian Medical University Union Hospital, Fuzhou 350000, China[11]Center for Respiratory Diseases China-Japan Friendship Hospital, Beijing 100029,China[12]Department of Respiratory Medicine, Capital Medical University, Beijing 100069,China[13]National Clinical Research Centre for Respiratory Disease, Beijing 100730, China[14]Department of Pulmonary and Critical Care Medicine，China-Japan FriendshipHospital
BackgroundThe effect of corticosteroids on influenza A(H1N1)pdm09 viral pneumonia patients remains controversial, and the impact of dosage has never been studied. MethodsUsing data of hospitalized adolescent and adult patients with influenza A(H1N1)pdm09 viral pneumonia, prospectively collected from 407 hospitals in mainland China, the effects of low-to-moderate-dose (25-150mgd(-1)) and high-dose (>150mgd(-1)) corticosteroids on 30-day mortality, 60-day mortality, and nosocomial infection were assessed with multivariate Cox regression and propensity score-matched case-control analysis. ResultsIn total, 2141 patients (median age: 34 years; morality rate: 15.9%) were included. Among them, 1160 (54.2%) had PaO2/FiO(2)<300mmHg on admission, and 1055 (49.3%) received corticosteroids therapy. Corticosteroids, without consideration of dose, did not influence either 30-day or 60-day mortality. Further analysis revealed that, as compared with the no-corticosteroid group, low-to-moderate-dose corticosteroids were related to reduced 30-day mortality (adjusted hazard ratio [aHR] 0.64 [95% CI 0.43-0.96, P=.033]). In the subgroup analysis among patients with PaO2/FiO(2)<300mmHg, low-to-moderate-dose corticosteroid treatment significantly reduced both 30-day mortality (aHR 0.49 [95% CI 0.32-0.77]) and 60-day mortality (aHR 0.51 [95% CI 0.33-0.78]), while high-dose corticosteroid therapy yielded no difference. For patients with PaO2/FiO(2) 300mmHg, corticosteroids (irrespective of dose) showed no benefit and even increased 60-day mortality (aHR 3.02 [95% CI 1.06-8.58]). Results were similar in the propensity model analysis. ConclusionsLow-to-moderate-dose corticosteroids might reduce mortality of influenza A(H1N1)pdm09 viral pneumonia patients with PaO2/FiO(2)<300mmHg. Mild patients with PaO2/FiO(2) 300mmHg could not benefit from corticosteroid therapy.
基金：
National Science Fund for Distinguished Young ScholarsNational Natural Science Foundation of China (NSFC)National Science Fund for Distinguished Young Scholars [81425001/H0104]; National Key Technology Support ProgramNational Key Technology R&D Program; Ministry of Science and Technology [2015BAI12B11]; Beijing Science and Technology Project [D151100002115004]
第一作者单位：[1]Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
通讯作者：
通讯机构：[11]Center for Respiratory Diseases China-Japan Friendship Hospital, Beijing 100029,China[12]Department of Respiratory Medicine, Capital Medical University, Beijing 100069,China[13]National Clinical Research Centre for Respiratory Disease, Beijing 100730, China[14]Department of Pulmonary and Critical Care Medicine，China-Japan FriendshipHospital[*1]NO. 2 Ying-hua Dong-jie, Chao-yang district, Beijing, 100029, China.
推荐引用方式(GB/T 7714)：
Li Hui,Yang Shi-gui,Gu Li,et al.Effect of low-to-moderate-dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia[J].INFLUENZA and OTHER RESPIRATORY VIRUSES.2017,11(4):345-354.doi:10.1111/irv.12456.
APA：
Li, Hui,Yang, Shi-gui,Gu, Li,Zhang, Yao,Yan, Xi-xin...&National Influenza A H1N1 pdm09 Clinical Investigation Group of China.(2017).Effect of low-to-moderate-dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia.INFLUENZA and OTHER RESPIRATORY VIRUSES,11,(4)
MLA：
Li, Hui,et al."Effect of low-to-moderate-dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia".INFLUENZA and OTHER RESPIRATORY VIRUSES 11..4(2017):345-354
