Table 1.
Clinical characteristics of pneumonia between glucocorticoid users and those glucocorticoids with immunosuppressant users
| Variables | Total, n=716 | Glucocorticoid users, n=297 | Glucocorticoid with immunosuppressant* users, n=419 | P value |
| Sex, female, n (%) | 341 (47.6) | 123 (41.4) | 218 (52.0) | 0.005 |
| Age, median (IQR) | 60 (49, 68) | 62.0 (52.0, 70.0) | 59.0 (46.0, 67.0) | <0.001 |
| Symptoms and signs, n (%) | ||||
| Fever | 534 (74.6) | 225 (75.8) | 309 (73.7) | 0.543 |
| Cough | 628 (87.7) | 267 (89.9) | 361 (86.2) | 0.133 |
| Sputum production | 580 (81.0) | 239 (80.5) | 341 (81.4) | 0.829 |
| Dyspnoea | 431 (60.2) | 185 (62.3) | 246 (58.7) | 0.335 |
| Disturbance of consciousness | 40 (5.6) | 11 (3.7) | 29 (6.9) | 0.065 |
| Laboratory examination | ||||
| White cell, ×109/L (IQR) | 7.94 (5.79, 11.60) | 9.27 (6.37, 12.63) | 7.51 (5.37, 10.97) | <0.001 |
| Neutrophils, ×109/L (IQR) | 6.49 (4.28, 10.08) | 7.35 (4.89, 10.83) | 6.05 (4.10, 9.35) | <0.001 |
| Lymphocyte, ×109/L (IQR) | 0.85 (0.50, 1.38) | 0.95 (0.60, 1.46) | 0.80 (0.45, 1.30) | 0.004 |
| Persistent lymphocytopenia | 304 (42.5) | 113 (38.0) | 191 (45.6) | 0.044 |
| Mean haemoglobin±SD (g/L) | 111.8±23.9 | 113.1±24.2 | 108.4±22.8 | 0.034 |
| Mean albumin±SD (g/L) | 32.4±6.4 | 33.3±6.2 | 29.9±6.1 | <0.001 |
| Lactate dehydrogenase (U/L) | 328.5 (227.8, 506.0) | 338.0 (226.0, 528.0) | 312.0 (228.5, 495.0) | 0.525 |
| Blood urea nitrogen (mmol/L) | 6.28 (4.60, 9.80) | 6.24 (4.60, 9.40) | 6.50 (4.63, 10.24) | 0.372 |
| Serum creatinine (mmol/L) | 64.0 (50.8, 90.2) | 62.6 (50.0, 81.2) | 65.9 (51.1, 99.1) | 0.157 |
| Procalcitonin (ng/mL) | 0.28 (0.12, 0.77) | 0.29 (0.14, 0.71) | 0.27 (0.11, 0.81) | 0.613 |
| Oxygenation index | 241.4 (126.6, 347.6) | 228.0 (128.1, 351.2) | 243.1 (122.4, 347.6) | <0.001 |
| Severe pneumonia index score | 76.5 (59.3, 101.0) | 77.0 (60.0, 103.0) | 76.0 (57.0, 100.0) | 0.845 |
| CURB-65 score >1 | 211 (29.5) | 88 (29.6) | 123 (1.0, 2.0) | 0.937 |
| Underlying immune defect, n (%) | ||||
| Diabetes mellitus | 179 (25.0) | 63 (21.2) | 116 (27.7) | 0.049 |
| Tumour | 43 (6.0) | 20 (6.7) | 23 (5.5) | 0.490 |
| Connective tissue disease† | 368 (51.4) | 111 (37.4) | 257 (61.3) | <0.001 |
| Interstitial lung disease | 324 (45.3) | 115 (38.7) | 209 (49.9) | 0.003 |
| Nephrotic syndrome or chronic glomerulonephritis | 90 (12.6) | 42 (14.1) | 48 (11.5) | 0.286 |
| Idiopathic interstitial pneumonia | 73 (10.2) | 56 (18.9) | 17 (4.1) | <0.001 |
| Bronchial asthma or chronic obstructive pulmonary disease | 30 (4.2) | 30 (10.1) | 0 (0) | <0.001 |
| Lymphoma | 17 (2.4) | 8 (2.7) | 9 (2.1) | 0.628 |
| Bone marrow or haematopoietic stem cell transplant | 7 (1.0) | 1 (0.3) | 6 (1.4) | 0.144 |
| Solid organ transplant | 63 (8.8) | 0 (0) | 63 (15.0) | <0.001 |
| Radiation pneumonitis | 8 (1.1) | 7 (2.4) | 1 (0.2) | 0.008 |
| Other immunocompromised hosts‡ | 65 (9.1) | 46 (15.5) | 19 (4.5) | <0.001 |
| Bronchoalveolar lavage, n (%) | 366 (51.1) | 248 (83.5) | 118 (28.2) | <0.001 |
| Total pathogenic positive rate | 500 (69.8) | 218 (73.4) | 282 (67.3) | 0.080 |
| Treatment, before admission, n (%) | ||||
| High-dose steroids (>1 mg/kg/day) | 216 (30.2) | 134 (45.1) | 82 (19.6) | <0.001 |
| Time of steroids use, median (IQR), month | 4.0 (2.0, 18.0) | 3.0 (1.6, 9.0) | 6.0 (2.0, 24.0) | <0.001 |
| Accumulated dose of glucocorticoids, methylprednisolone, g (IQR) | 38 (1.9, 8.8) | 3.0 (1.5, 5.4) | 4.8 (2.2, 12.5) | <0.001 |
| Antibiotics | 502 (70.1) | 219 (73.7) | 283 (67.5) | 0.074 |
| Antiviral drugs | 113 (15.8) | 44 (14.8) | 69 (16.5) | 0.550 |
| Treatment, during hospitalisation, n (%) | ||||
| Anti-Pseudomonas aeruginosa drugs | 547 (76.4) | 220 (74.1) | 327 (78.0) | 0.218 |
| Voriconazole or caspofungin | 282 (39.4) | 105 (35.4) | 177 (42.2) | 0.063 |
| Ganciclovir | 336 (46.9) | 120 (40.4) | 216 (51.6) | 0.003 |
| Trimethoprim | 333 (46.5) | 111 (37.4) | 222 (53.0) | <0.001 |
| Complications, n (%) | ||||
| Non-invasive ventilation | 173 (24.2) | 63 (21.2) | 110 (26.3) | 0.121 |
| Invasive mechanical ventilation | 172 (24.0) | 70 (23.6) | 102 (24.3) | 0.811 |
| Mechanical ventilation | 258 (36.0) | 106 (35.7) | 152 (36.3) | 0.872 |
| Respiratory failure | 364 (50.8) | 155 (52.2) | 209 (49.9) | 0.543 |
| ICU admission | 292 (40.8) | 116 (39.1) | 176 (42.0) | 0.429 |
| Septic shock during hospitalisation | 154 (21.5) | 64 (21.5) | 90 (21.5) | 0.982 |
| CAP | 635 (88.7) | 263 (88.6) | 372 (88.8) | 0.924 |
| Extracorporeal membrane oxygenation | 36 (5.0) | 15 (5.1) | 21 (5.0) | 0.981 |
| 30-day mortality | 162 (22.6) | 66 (22.2) | 96 (22.9) | 0.828 |
| 90-day mortality | 186 (26.0) | 76 (25.6) | 110 (26.3) | 0.842 |
*Other immunosuppressants: methotrexate, cyclosporine, cyclophosphamide, tacrolimus, sirolimus and azathioprine.
†Connective tissue disorders: rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, polymyositis, systemic sclerosis, Sjogren’s syndrome, and so on. Immunosuppressive drugs: glucocorticoid, tacrolimus, sirolimus, cyclosporine, methotrexate, and so on.
‡Other immunocompromised hosts: eczema, myelitis, autoimmune encephalitis, idiopathic thrombocytopenic purpura, and so on.
CAP, community-acquired pneumonia; CURB-65, Confusion, uremia, elevated respiratory rate, hypotension, and aged 65 years or older; ICU, intensive care unit.