Effects of Empirical Glucocorticoid Use on Severe Acute Exacerbation of COPD During Hospitalization

Abstract

Ling Wu,1,* Nan Lan,2,* Xiaoyu Yang3 1Department of Respiratory Medicine, The First People’s Hospital of Shuangliu District, Chengdu, People’s Republic of China; 2Department of Respiratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China; 3Department of Respiratory Medicine, Peking University First Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaoyu Yang Email [email protected]: Clinicians’ selection of glucocorticoids during hospitalization of COPD patients is often based on the medical staff’s judgment of the patient’s condition, and there is no objective judgment standard. The purpose of this study was to investigate the outcome of severe COPD deterioration in patients treated with glucocorticoid and without glucocorticoid during hospitalization.Methods: This study was an observational cohort study. Data on hospitalization with severe COPD deterioration were collected and followed up for 1 year. One year after discharge, the re-hospitalization due to COPD was collected retrospectively. The patients were divided into glucocorticoid group and control group according to whether the patients were given glucocorticoid therapy or not when they were admitted to hospital for the first time. The primary outcome was rate of future COPD exacerbations, while the secondary outcome was hospital stay, treatment cost and COPD-related readmission time. These results are analyzed by using Poisson model and Cox regression model.Results: A total of 91 patients were enrolled in the study, including 39 in the control group and 52 in the glucocorticoid group. The annual rate of future COPD exacerbations in the glucocorticoid group was significantly lower than that in the control group (RR,0.50 [95% CI, 0.26– 0.98]; P = 0.045). The risk of COPD recurrence in the glucocorticoid group was lower than that in the control group, as assessed in a time-to-first-event analysis (HR,0.46[95% CI 0.22– 0.97]; P = 0.042). Subgroup analysis found that in patients with blood eosinophil < 100 cells/μ l, the future annual severe exacerbation rate of glucocorticoid group was significantly lower than that in the control group (adjusted RR,0.37 [95% CI 0.17– 0.83]; P = 0.016).Conclusion: The use of glucocorticoids during hospitalization in COPD can more effectively reduce the severe deterioration of COPD than without glucocorticoids.Keywords: COPD, glucocorticoid, exacerbation

Keywords

• copd，glucocorticoid ，exacerbation