机构：[1]Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.北京朝阳医院[2]State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.浙江大学医学院附属第一医院[3]Shenzhen Third People’s Hospital, Shenzhen City, Guangdong Province, China.[4]Guangzhou No. 8 People’s Hospital, Guangzhou City, Guangdong Province, China.[5]Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.[6]First Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China.[7]Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.[8]The First Affiliated Hospital, Wenzhou Medical College, Wenzhou City, Zhejiang Province, China.[9]The First Affiliated Hospital, Medical College of Soochow University, Suzhou, Jiangsu Province, China.[10]Beijing Ditan Hospital, Capital Medical University, Beijing, China.[11]Global Health, Population and Nutrition, Global Research and Services, Family Health International 360, Durham, NC.[12]Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical school, Nanjing University, Nanjing City, Jiangsu Province, China.[13]Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing City, Jiangsu Province, China.[14]The Second Affiliated Hospital of the Southeast University, Nanjing City, Jiangsu Province, China.[15]Yantai Yu Huang-Ding Hospital, Yantai City, Shandong Province, China.[16]Affiliated Hospital of Zunyi Medical College, Zunyi City, Guizhou Province, China.[17]Zaozhuang Municipal Hospital, Zaozhuang City, Shandong Province, China.[18]Global Health, Population & Nutrition, Family Health International 360, Duke University, Durham, NC.[19]China-Japan Friendship Hospital, Beijing, China.
To determine the impact of adjuvant corticosteroids administered to patients hospitalized with influenza A (H7N9) viral pneumonia.
The effects of adjuvant corticosteroids on mortality were assessed using multivariate Cox regression and a propensity score-matched case-control study. Nosocomial infections and viral shedding were also compared.
Hospitals with influenza A (H7N9) viral pneumonia patient admission in 84 cities and 16 provinces of Mainland China.
Adolescent and Adult patients aged >14 yr with severe laboratory-confirmed influenza A (H7N9) virus infections were screened from April 2013 to March 2015.
None.
The study population comprised 288 cases who were hospitalized with influenza A (H7N9) viral pneumonia. The median age of the study population was 58 years, 69.8% of the cohort comprised male patients, and 51.4% had at least one type of underlying diseases. The in-hospital mortality was 31.9%. Two hundred and four patients (70.8%) received adjuvant corticosteroids; among them, 193 had hypoxemia and lung infiltrates, 11 had chronic obstructive pulmonary disease, and 11 had pneumonia only. Corticosteroids were initiated within 7 days (interquartile range, 5.0-9.4 d) of the onset of illness and the maximum dose administered was equivalent to 80-mg methylprednisolone (interquartile range, 40-120 mg). The patients were treated with corticosteroids for a median duration of 7 days (interquartile range, 4.0-11.3 d). Cox regression analysis showed that compared with the patients who did not receive corticosteroid, those who received corticosteroid had a significantly higher 60-day mortality (adjusted hazards ratio, 1.98; 95% CI, 1.03-3.79; p = 0.04). Subgroup analysis showed that high-dose corticosteroid therapy (> 150 mg/d methylprednisolone or equivalent) significantly increased both 30-day and 60-day mortality, whereas no significant impact was observed for low-to-moderate doses of corticosteroids (25-150 mg/d methylprednisolone or equivalent). The propensity score-matched case-control analysis showed that the median viral shedding time was much longer in the group that received high-dose corticosteroids (15 d), compared with patients who did not receive corticosteroids (13 d; p = 0.039).
High-dose corticosteroids were associated with increased mortality and longer viral shedding in patients with influenza A (H7N9) viral pneumonia.
基金：
Dr. Cao was supported by grant from the National Science Fund for Distinguished
Young Scholars (grant number 81425001/H0104), grants
from the National Natural Science Foundation of China (81271840/
H1904 and 81030032/H19), and the National Program for the Prevention
and Control of Human Infections by Avian-Origin H7N9 Influenza A
Virus (KJYJ-2013-01-05).
第一作者机构：[1]Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.[19]China-Japan Friendship Hospital, Beijing, China.
共同第一作者：
通讯作者：
通讯机构：[1]Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.[19]China-Japan Friendship Hospital, Beijing, China.
推荐引用方式(GB/T 7714)：
Bin Cao,Hainv Gao,Boping Zhou,et al.Adjuvant Corticosteroid Treatment in Adults With Influenza A (H7N9) Viral Pneumonia.[J].CRITICAL CARE MEDICINE.2016,44(6):E318-E328.doi:10.1097/CCM.0000000000001616.
APA：
Bin Cao,Hainv Gao,Boping Zhou,Xilong Deng,Chengping Hu...&Lanjuan Li.(2016).Adjuvant Corticosteroid Treatment in Adults With Influenza A (H7N9) Viral Pneumonia..CRITICAL CARE MEDICINE,44,(6)
MLA：
Bin Cao,et al."Adjuvant Corticosteroid Treatment in Adults With Influenza A (H7N9) Viral Pneumonia.".CRITICAL CARE MEDICINE 44..6(2016):E318-E328
医学