DOI: 10.5061/dryad.mkkwh70x2
title: Aetiology and prognostic risk factors of mortality in pneumonia patients receiving glucocorticoids alone or glucocorticoids and other immunosuppressants: a retrospective cohort study

description: Objectives: Long-term use of high-dose glucocorticoids can lead to severe
 immunosuppression and increased risk of treatment-resistant pneumonia and
 mortality. We investigated the aetiology and prognostic risk factors of
 mortality in hospitalised patients who developed pneumonia while receiving
 glucocorticoid therapy alone or glucocorticoid and other immunosuppressant
 therapies. Design: Retrospective cohort study Setting: Six secondary and
 tertiary academic hospitals in China Participants: Patients receiving
 glucocorticoids who were hospitalised with pneumonia between 1st January
 2013 and 31st December 2019. Main Outcomes: We analysed the prevalence of
 comorbidities, microbiology, antibiotic susceptibility patterns, 30-day
 and 90-day mortality rates, and prognostic risk factors. Results: A total
 of 716 patients were included, with pneumonia pathogens identified in
 69.8% of patients. Significant morbidities occurred, including respiratory
 failure (50.8%), intensive care unit (ICU) transfer (40.8%), and
 mechanical ventilation (36%), with a 90-day mortality rate of 26.0%.
 Diagnosis of pneumonia occurred within 6 months of glucocorticoid
 initiation for 69.7% of patients with Cytomegalovirus (CMV) pneumonia and
 79.0% of patients with Pneumocystis jirovecii pneumonia (PCP). Pathogens,
 including Pneumocystis, CMV, and multidrug-resistant bacteria, were
 identified more frequently in patients with persistent lymphocytopenia and
 high-dose glucocorticoid treatment (≥ 30 mg/day of prednisolone or
 equivalent within 30 days before admission). The 90-day mortality rate was
 significantly lower for non-CMV viral pneumonias than for PCP (P &lt;
 0.05), with a similar mortality rate as CMV pneumonias (24.2% vs 38.1% vs
 27.4%, respectively).Cox regression analysis indicated several independent
 negative predictors for mortality in this patient population, including
 septic shock, respiratory failure, persistent lymphocytopenia,
 interstitial lung disease, and high-dose glucocorticoid use. Conclusions:
 Patients who developed pneumonia while receiving glucocorticoid therapy
 experienced high rates of opportunistic infections, with significant
 morbidity and mortality. These findings should be carefully considered
 when determining treatment strategies for this patient population.
description: We retrospectively recruited patients with pneumonia who were
 hospitalised between 1<sup>st</sup> January 2013 and
 31<sup>st</sup> December 2017 at six secondary and tertiary
 academic hospitals in China. We identified patients with connective tissue
 diseases, nephrotic syndrome or chronic glomerulonephritis, idiopathic
 interstitial pneumonia, bronchial asthma, chronic obstructive pulmonary
 disease, or other causes for immunosuppressive therapy. Study patients
 were then selected based on the following inclusion criteria: (1) oral or
 intravenous glucocorticoid treatment [7-9] before admission;<sup>
 </sup>(2) pneumonia diagnosis on admission or during
 hospitalisation; and (3) at least 16 years of age. The exclusion criteria
 were as follows: (1) diagnosis of noninfectious pulmonary diseases,
 including lung cancer, interstitial lung diseases without infection,
 pulmonary embolism, or heart failure; (2) inability to provide consent for
 procedures.
description: No.