Table 5.
Clinical characteristics of pneumonia with glucocorticoid users in different underlying disease
| Variables | Connective tissue disease, n=368 | Nephrotic syndrome or chronic glomerulonephritis, n=90 |
Solid organ transplant, n=63 |
Bone marrow or HSCT, n=7 |
Lymphoma, n=17 |
Bronchial asthma or COPD, n=30 |
Idiopathic interstitial pneumonia, n=73 |
Radiation pneumonitis, n=8 |
P value |
| Sex, female, n (%) | 228 (62.0) | 28 (31.1) | 15 (23.8) | 1 (14.3) | 4 (23.5) | 9 (30.0) | 28 (38.4) | 0 (0) | <0.001 |
| Age, median (IQR) | 60.0 (47.3, 69.8) | 57.0 (41.8, 66.0) | 56.0 (46.0, 63.0) | 33.0 (32.0, 53.0) | 65.0 (53.5, 75.0) | 62.0 (57.0, 73.3) | 65.0 (55.0, 71.0) | 62.5 (52.0, 66.8) | <0.001 |
| Laboratory examination | |||||||||
| White cell, ×109/L (IQR) | 7.79 (5.72, 11.19) | 8.31 (6.47, 11.81) | 6.92 (4.45, 9.93) | 5.27 (3.80, 11.6) | 5.16 (2.85, 9.23) | 9.42 (6.59, 12.82) | 9.58 (7.15, 12.91) | 6.95 (5.52, 10.82) | 0.001 |
| Neutrophils, ×109/L (IQR) | 6.36 (4.29, 9.80) | 7.48 (5.30, 10.81) | 4.80 (3.2, 7.7) | 3.85 (0.90, 7.05) | 3.52 (1.89, 7.91) | 6.94 (4.45, 9.13) | 8.13 (4.87, 11.07) | 6.16 (5.20, 9.50) | <0.001 |
| Lymphocyte, ×109/L (IQR) | 0.83 (0.50, 1.34) | 0.77 (0.40, 1.22) | 0.80 (0.33, 1.31) | 0.61 (0.43, 2.07) | 0.86 (0.38, 1.42) | 1.15 (0.76, 1.73) | 1.10 (0.70, 1.61) | 0.50 (0.09, 0.94) | 0.014 |
| Persistent lymphocytopenia | 160 (43.5) | 39 (43.3) | 29 (46.0) | 3 (42.9) | 8 (47.1) | 8 (26.7) | 29 (39.7) | 5 (62.5) | 0.634 |
| Oxygenation index | 243.1 (126.6, 343.8) | 176.5 (103.4, 279.0) | 323.8 (207.1, 424.5) | 265.5 (148.8, 304.7) | 197.8 (80.0, 350.7) | 264.6 (181.6, 444.0) | 242.9 (128.0, 364.3) | 307.4 (244.1, 442.0) | 0.001 |
| Severe pneumonia index score | 73.0 (54.0, 96.0) | 88.0 (67.8, 113.5) | 83.0 (64.0, 100.0) | 64.0 (42.0, 86.0) | 96.0 (73.5, 141.5) | 74.5 (60.8, 92.5) | 75.0 (63.0, 96.5) | 91.5 (85.0, 131.0) | <0.001 |
| CURB-65 score >1 | 105 (28.5) | 34 (37.8) | 15 (23.8) | 1 (14.3) | 4 (23.5) | 6 (20.0) | 25 (34.2) | 2 (25.0) | 0.391 |
| Imaging features, n (%) | 316 (85.9) | 74 (82.2) | 61 (96.8) | 5 (71.4) | 13 (76.5) | 21 (70.0) | 67 (91.8) | 6 (75.0) | |
| Consolidation or mass | 163 (51.6) | 41 (55.4) | 23 (37.7) | 3 (60.0) | 5 (38.5) | 7 (23.3) | 19 (28.4) | 5 (83.3) | 0.005 |
| Ground-glass opacity | 203 (64.2) | 50 (67.6) | 29 (47.5) | 2 (40.0) | 8 (61.5) | 16 (53.3) | 51 (76.1) | 4 (66.7) | 0.04 |
| Total pathogenic positive rate | |||||||||
| Bacteria | 104 (28.3) | 29 (32.2) | 31 (49.2) | 2 (28.6) | 2 (11.8) | 11 (36.7) | 18 (24.7) | 4 (50.0) | 0.015 |
| PCP | 63 (17.1) | 40 (44.4) | 10 (15.9) | 0 (0) | 4 (23.5) | 3 (10.0) | 12 (16.4) | 3 (37.5) | <0.001 |
| Aspergillus | 33 (9.0) | 9 (10.0) | 26 (41.3) | 0 (0) | 1 (5.9) | 5 (16.7) | 10 (13.7) | 2 (25.0) | <0.001 |
| CMV | 85 (23.1) | 41 (45.6) | 15 (23.8) | 3 (42.9） | 8 (47.1) | 4 (13.3) | 26 (35.6) | 5 (62.5) | <0.001 |
| Non-CMV virus | 56 (15.2) | 12 (13.3) | 47 (74.6) | 2 (28.6) | 4 (23.5) | 3 (10.0) | 28 (38.4) | 1 (12.5) | <0.001 |
| Treatment, before admission, n (%) | |||||||||
| High-dose steroids use | 140 (38.0) | 32 (35.6) | 3 (4.8) | 1 (14.3) | 9 (52.9) | 7 (23.3) | 27 (37.0) | 3 (37.5) | <0.001 |
| Accumulated dose of glucocorticoids, methylprednisolone, g (IQR) | 5.4 (2.4, 13.7) | 3.8 (2.5, 6.6) | 1.9 (0.9, 3.3) | 1.3 (0.6, 7.3) | 2.9 (2.4, 36) | 0.6 (0.3, 2.4) | 3.6 (2.0, 6.5) | 5.9 (3.1, 6.7) | <0.001 |
| Time of steroids use (month) | 5.9 (2.0, 29.8) | 3.0 (3.0, 11.0) | 7.0 (2.0, 15.0) | 6.0 (3.0, 18.0) | 3.5 (2.0, 5.0) | 1.0 (1.0, 13.5) | 3.5 (2.0, 12.0) | 3.0 (2.0, 8.0) | 0.024 |
| Receiving other immunosuppressants | 257 (69.8) | 48 (53.3) | 63 (100.0) | 6 (85.7) | 9 (52.9) | 0 (0) | 17 (23.3) | 1 (12.5) | <0.001 |
| Complications, n (%) | |||||||||
| Non-invasive ventilation | 98 (26.6) | 25 (27.8) | 8 (12.7) | 1 (14.3) | 4 (23.5) | 3 (10.0) | 19 (26.0) | 2 (25.0) | 0.183 |
| Invasive mechanical ventilation | 89 (24.2) | 25 (27.8) | 10 (15.9) | 1 (14.3) | 4 (23.5) | 6 (20.0) | 24 (32.9) | 0 (0) | 0.237 |
| Respiratory failure | 179 (48.6) | 58 (64.4) | 24 (38.1) | 3 (42.9) | 6 (35.3) | 14 (46.7) | 41 (56.2) | 3 (37.5) | 0.040 |
| ICU care | 152 (41.3) | 49 (54.4) | 14 (22.2) | 3 (42.9) | 6 (35.3) | 6 (20.0) | 35 (47.9) | 1 (12.5) | 0.001 |
| Septic shock | 68 (18.5) | 25 (27.8) | 15 (23.8) | 2 (28.6) | 4 (23.5) | 5 (16.7) | 20 (27.4) | 2 (25.0) | 0.481 |
| Extracorporeal membrane oxygenation | 15 (4.1) | 4 (4.4) | 4 (6.3) | 0 (0) | 1 (5.9) | 0 (0) | 10 (13.7) | 0 (0) | 0.044 |
| 30-day mortality | 88 (23.9) | 23 (25.6) | 8 (12.7) | 2 (28.6) | 3 (17.6) | 4 (13.3) | 17 (23.3) | 2 (25.0) | 0.509 |
| 90-day mortality | 103 (28.0) | 25 (27.8) | 9 (14.3) | 2 (28.6) | 4 (23.5) | 6 (20.0) | 20 (27.4) | 2 (25.0) | 0.528 |
CMV, Cytomegalovirus; COPD, chronic obstructive pulmonary disease; CURB-65, Confusion, uremia, elevated respiratory rate, hypotension, and aged 65 years or older; HSCT, haematopoietic stem cell transplant; ICU, intensive care unit; PCP, Pneumocystis jirovecii pneumonia.