Background
Methods
Data source
Patient selection
Variables and endpoints
Statistical analysis
Results
Patients
Characteristic | No corticosteroid | Low-dose corticosteroids | High-dose corticosteroids | ||||
---|---|---|---|---|---|---|---|
n = 1829 |
n = 267 |
n = 132 |
p value | ||||
Patient Characteristics | |||||||
Age, years | 49.2 | ±22.6 | 49.8 | ±21.1 | 53.7 | ±22.3 | 0.0760 |
Male | 847 | (46.3) | 106 | (39.7) | 69 | (52.3) | 0.0405 |
Preexisting comorbid conditions | |||||||
Charlson comorbidity index | 0.63 | ±1.0 | 1.17 | ±1.2 | 0.88 | ±0.9 | < 0.0001 |
Congestive heart failure | 108 | (5.9) | 35 | (13.1) | 10 | (7.6) | < 0.0001 |
Renal disease | 32 | (1.8) | 3 | (1.1) | 2 | (1.5) | 0.7493 |
Liver disease | 92 | (5.0) | 5 | (1.9) | 6 | (4.5) | 0.0717 |
Diabetes without chronic complications | 144 | (7.9) | 25 | (9.4) | 17 | (12.9) | 0.1086 |
Diabetes with chronic complications | 33 | (1.8) | 6 | (2.2) | 1 | (0.8) | 0.5723 |
Chronic obstructive pulmonary disease | 85 | (4.6) | 22 | (8.2) | 8 | (6.1) | 0.0413 |
Bronchial asthma | 157 | (8.6) | 110 | (41.2) | 31 | (23.5) | < 0.0001 |
Interstitial lung disease and fibrosis | 62 | (3.4) | 19 | (7.1) | 34 | (25.8) | < 0.0001 |
Pleural effusion | 117 | (6.4) | 14 | (5.2) | 11 | (8.3) | 0.4910 |
Aspiration or drainage of pleural effusion | 4 | (0.2) | 3 | (1.1) | 2 | (1.5) | 0.0108 |
Pneumonia characteristics | |||||||
Parameters of the A-DROP | |||||||
Age (male ≥ 70 years, female ≥ 75 years) | 473 | (25.9) | 58 | (21.7) | 43 | (32.6) | 0.0642 |
Dehydration | 201 | (11.0) | 39 | (14.6) | 19 | (14.4) | 0.1344 |
Confusion | 196 | (10.7) | 63 | (23.6) | 56 | (42.4) | < 0.0001 |
Respiratory failure | 38 | (2.1) | 12 | (4.5) | 8 | (6.1) | 0.0025 |
Low blood pressure | 176 | (9.6) | 37 | (13.9) | 17 | (12.9) | 0.0638 |
Pneumonia severity | |||||||
Mild | 1110 | (60.7) | 137 | (51.3) | 48 | (36.4) | < 0.0001 |
Moderate | 645 | (35.3) | 111 | (41.6) | 75 | (56.8) | |
Severe | 58 | (3.2) | 14 | (5.2) | 6 | (4.5) | |
Extremely severe | 16 | (0.9) | 5 | (1.9) | 3 | (2.3) | |
Other treatments | |||||||
Anti-mycoplasmal drug use | |||||||
Macroride | 695 | (38.0) | 104 | (39.0) | 49 | (37.1) | 0.9314 |
Quinolone | 548 | (30.0) | 116 | (43.4) | 69 | (52.3) | < 0.0001 |
Tetracycline | 569 | (31.1) | 78 | (29.2) | 30 | (22.7) | 0.1172 |
Other supportive drug use | |||||||
Catecholamine | 13 | (0.7) | 5 | (1.9) | 8 | (6.1) | < 0.0001 |
Interventions | |||||||
Invasive ventilation | 10 | (0.5) | 5 | (1.9) | 12 | (9.1) | < 0.0001 |
Non-invasive ventilation | 2 | (0.1) | (0.0) | 2 | (1.5) | 0.0009 | |
Organization characteristics | |||||||
Intensive care unit admission | 8 | (0.4) | 5 | (1.9) | 10 | (7.6) | < 0.0001 |
Academic hospital | 131 | (7.2) | 16 | (6.0) | 17 | (12.9) | 0.0345 |
Average number of patients in hospital per day | |||||||
≤ 200 | 351 | (19.2) | 40 | (15.0) | 26 | (19.7) | 0.2502 |
201–600 | 1194 | (65.3) | 190 | (71.2) | 81 | (61.4) | |
≥ 601 | 284 | (15.5) | 37 | (13.9) | 25 | (18.9) |
Characteristic | No corticosteroid | Low-dose corticosteroids | |||
---|---|---|---|---|---|
n = 251 |
n = 251 |
p value | |||
Patient Characteristics | |||||
Age, years | 49.9 | ±21.6 | 49.6 | ±21.5 | 0.8753 |
Male | 110 | (43.8) | 101 | (40.2) | 0.4695 |
Preexisting comorbid conditions | |||||
Charlson comorbidity index | 1.25 | ±1.3 | 1.08 | ±1.1 | 0.1921 |
Congestive heart failure | 30 | (12.0) | 30 | (12.0) | 1.0000 |
Renal disease | 5 | (2.0) | 3 | (1.2) | 0.7244 |
Liver disease | 6 | (2.4) | 5 | (2.0) | 1.0000 |
Diabetes without chronic complications | 27 | (10.8) | 25 | (10.0) | 0.8837 |
Diabetes with chronic complications | 8 | (3.2) | 6 | (2.4) | 0.7875 |
Chronic obstructive pulmonary disease | 25 | (10.0) | 20 | (8.0) | 0.5324 |
Bronchial asthma | 103 | (41.0) | 96 | (38.2) | 0.5841 |
Interstitial lung disease and fibrosis | 12 | (4.8) | 16 | (6.4) | 0.5603 |
Pleural effusion | 12 | (4.8) | 13 | (5.2) | 1.0000 |
Aspiration or drainage of pleural effusion | 2 | (0.8) | 2 | (0.8) | 1.0000 |
Pneumonia characteristics | |||||
Parameters of the A-DROP | |||||
Age (male ≥70 years, female ≥75 years) | 61 | (24.3) | 57 | (22.7) | 0.7523 |
Dehydration | 40 | (15.9) | 35 | (13.9) | 0.6167 |
Confusion | 47 | (18.7) | 54 | (21.5) | 0.5043 |
Respiratory failure | 8 | (3.2) | 9 | (3.6) | 1.0000 |
Low blood pressure | 29 | (11.6) | 31 | (12.4) | 0.8907 |
Pneumonia severity | |||||
Mild | 137 | (54.6) | 135 | (53.8) | 0.9527 |
Moderate | 97 | (38.6) | 100 | (39.8) | |
Severe | 13 | (5.2) | 11 | (4.4) | |
Extremely severe | 4 | (1.6) | 5 | (2.0) | |
Other treatments | |||||
Anti-mycoplasmal drug use | |||||
Macroride | 89 | (35.5) | 94 | (37.5) | 0.7107 |
Quinolone | 104 | (41.4) | 106 | (42.2) | 0.9279 |
Tetracycline | 68 | (27.1) | 75 | (29.9) | 0.5531 |
Other supportive drug use | |||||
Catecholamine | 4 | (1.6) | 4 | (1.6) | 1.0000 |
Interventions | |||||
Invasive ventilation | 5 | (2.0) | 4 | (1.6) | 1.0000 |
Non-invasive ventilation | 0 | (0.0) | 0 | (0.0) | |
Organization characteristics | |||||
Intensive care unit admission | 4 | (1.6) | 5 | (2.0) | 1.0000 |
Academic hospital | 12 | (4.8) | 15 | (6.0) | 0.6931 |
Average number of patients in hospital per day | |||||
≤ 200 | 44 | (17.5) | 40 | (15.9) | 0.7962 |
201–600 | 169 | (67.3) | 176 | (70.1) | |
≥ 601 | 38 | (15.1) | 35 | (13.9) |
Characteristic | No corticosteroid | High-dose corticosteroids | |||
---|---|---|---|---|---|
n = 120 | n = 120 |
p value | |||
Patient Characteristics | |||||
Age, years | 55.2 | ±22.7 | 52.5 | ±22.5 | 0.3607 |
Male | 65 | (54.2) | 63 | (52.5) | 0.8971 |
Preexisting comorbid conditions | |||||
Charlson comorbidity index | 1.01 | ±1.1 | 0.90 | ±0.9 | 0.6511 |
Congestive heart failure | 11 | (9.2) | 9 | (7.5) | 0.8160 |
Renal disease | 1 | (0.8) | 2 | (1.7) | 1.0000 |
Liver disease | 4 | (3.3) | 6 | (5.0) | 0.7486 |
Diabetes without chronic complications | 15 | (12.5) | 14 | (11.7) | 1.0000 |
Diabetes with chronic complications | (0.0) | 1 | (0.8) | 1.0000 | |
Chronic obstructive pulmonary disease | 11 | (9.2) | 8 | (6.7) | 0.6336 |
Bronchial asthma | 39 | (32.5) | 30 | (25.0) | 0.2538 |
Interstitial lung disease and fibrosis | 23 | (19.2) | 24 | (20.0) | 1.0000 |
Pleural effusion | 10 | (8.3) | 10 | (8.3) | 1.0000 |
Aspiration or drainage of pleural effusion | 1 | (0.8) | 1 | (0.8) | 1.0000 |
Pneumonia characteristics | |||||
Parameters of the A-DROP | |||||
Age (male ≥70 years, female ≥75 years) | 40 | (33.3) | 36 | (30.0) | 0.6773 |
Dehydration | 22 | (18.3) | 18 | (15.0) | 0.6037 |
Confusion | 43 | (35.8) | 45 | (37.5) | 0.8935 |
Respiratory failure | 6 | (5.0) | 6 | (5.0) | 1.0000 |
Low blood pressure | 23 | (19.2) | 16 | (13.3) | 0.2937 |
Pneumonia severity | |||||
Mild | 45 | (37.5) | 48 | (40.0) | 0.7779 |
Moderate | 64 | (53.3) | 64 | (53.3) | |
Severe | 5 | (4.2) | 5 | (4.2) | |
Extremely severe | 6 | (5.0) | 3 | (2.5) | |
Other treatments | |||||
Anti-mycoplasmal drug use | |||||
Macroride | 44 | (36.7) | 45 | (37.5) | 1.0000 |
Quinolone | 49 | (40.8) | 59 | (49.2) | 0.2429 |
Tetracycline | 28 | (23.3) | 28 | (23.3) | 1.0000 |
Other supportive drug use | |||||
Catecholamine | 8 | (6.7) | 5 | (4.2) | 0.5702 |
Interventions | |||||
Invasive ventilation | 7 | (5.8) | 7 | (5.8) | 1.0000 |
Non-invasive ventilation | 1 | (0.8) | 2 | (1.7) | 1.0000 |
Organization characteristics | |||||
Intensive care unit admission | 5 | (4.2) | 6 | (5.0) | 1.0000 |
Academic hospital | 11 | (9.2) | 15 | (12.5) | 0.5339 |
Average number of patients in hospital per day | |||||
≤ 200 | 18 | (15.0) | 23 | (19.2) | 0.6922 |
201–600 | 79 | (65.8) | 75 | (62.5) | |
≥ 601 | 23 | (19.2) | 22 | (18.3) |
Endpoints
Characteristic | No corticosteroid | Low-dose corticosteroids | High-dose corticosteroids | ||||
---|---|---|---|---|---|---|---|
n = 1829 |
n = 267 |
n = 132 |
p value | ||||
30-day mortality | 14 | (0.8) | 5 | (1.9) | 7 | (5.3) | < 0.0001 |
In-hospital hyperglycemia requiring insulin treatment | 104 | (5.7) | 30 | (11.2) | 31 | (23.5) | < 0.0001 |
Length of stay, days | 13.1 | ±12.8 | 18.0 | ±18.8 | 23.6 | ±18.5 | < 0.0001 |
Length of anitmicrobial treatment, days | 6.8 | ±4.8 | 9.3 | ±7.3 | 9.5 | ±6.3 | < 0.0001 |
Total cost of all drugs in hospitalization | |||||||
Japanese Yen ± SD | 49,799 | ±99,142 | 107,656 | ±243,792 | 161,980 | ±225,494 | < 0.0001 |
Euro ± SD | 428 | ±851 | 924 | ±2093 | 1391 | ±1936 | |
US Dollar ± SD | 492 | ±979 | 1063 | ±2408 | 1600 | ±2227 |
Characteristic | No corticosteroid | Low-dose corticosteroids | |||
---|---|---|---|---|---|
n = 251 |
n = 251 |
p value | |||
30-day mortality | 5 | (2.0) | 5 | (2.0) | 1.0000 |
In-hospital hyperglycemia requiring insulin treatment | 20 | (8.0) | 30 | (12.0) | 0.1794 |
Length of stay, days | 12.8 | ±9.1 | 17.6 | ±18.0 | 0.0055 |
Length of anitmicrobial treatment, days | 7.1 | ±5.1 | 8.9 | ±6.7 | 0.0026 |
Total cost of all drugs in hospitalization | |||||
Japanese Yen ± SD | 63,265 | ±142,385 | 103,566 | ±237,757 | < 0.0001 |
Euro ± SD | 543 | ±1223 | 889 | ±2042 | |
US Dollar ± SD | 625 | ±1406 | 1023 | ±2348 |
Characteristic | No corticosteroid | High-dose corticosteroids | |||
---|---|---|---|---|---|
n = 122 |
n = 122 |
p value | |||
30-day mortality | 4 | (3.3) | 6 | (5.0) | 0.7486 |
In-hospital hyperglycemia requiring insulin treatment | 6 | (5.0) | 26 | (21.7) | 0.0002 |
Length of stay, days | 15.4 | ±17.8 | 22.8 | ±18.2 | < 0.0001 |
Length of anitmicrobial treatment, days | 6.9 | ±5.2 | 9.4 | ±6.4 | 0.0005 |
Total cost of all drugs in hospitalization | |||||
Japanese Yen ± SD | 94,905 | ±222,024 | 145,767 | ±203,214 | < 0.0001 |
Euro ± SD | 815 | ±1907 | 1252 | ±1745 | |
US Dollar ± SD | 937 | ±2193 | 1440 | ±2007 |