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ORIGINAL RESEARCH article

Front. Pharmacol.
Sec. Respiratory Pharmacology
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1445979

The Glucocorticoid Dose-Mortality Nexus in Pneumonia Patients: Unveiling the Threshold Effect

Provisionally accepted
Saibin Wang Saibin Wang *Qian Ye Qian Ye
  • Jinhua Municipal Central Hospital, Jinhua, China

The final, formatted version of the article will be published soon.

    Background: The impact of glucocorticoid use on mortality risk in pneumonia patients remains unclear. This study aimed to investigate the relationship between the accumulated dose of glucocorticoids (ADG) and secondary pneumonia mortality risk among patients receiving oral or intravenous glucocorticoids. Methods: Data from the DRYAD database were analyzed, covering pneumonia patients from six academic hospitals over a five-year period who had been administered oral or intravenous glucocorticoids. Piecewise linear regression and multivariate regression analysis were utilized to assess the association between ADG and mortality risk in pneumonia patients, while adjusting for potential confounders. Results: Among the 628 pneumonia patients included, the 30-day mortality rate was 23.1% and the 90-day mortality rate was 26.4%. In the high-dose glucocorticoid group (≥24 mg/day of methylprednisolone or an equivalent glucocorticoid within 30 days before admission), the 30-day and 90-day mortality rates were 31.2% and 35.9%, respectively. Piecewise linear regression analysis demonstrated a non-linear relationship between ADG and mortality risk in pneumonia patients. Multivariate regression analysis revealed a significantly lower mortality risk in patients receiving an ADG of 20-39g methylprednisolone compared to those receiving lower (<20g) or higher doses (≥40g), after adjusting for potential confounding factors. Additionally, in the high-dose glucocorticoid group, surpassing the inflection point of 20g of methylprednisolone raised the 30-day and 90-day mortality risks (adjusted odds ratio, 95% confidence interval: 1.16, 1. 03-1.30 and 1.23, 1.07-1.42, respectively). Notably, this threshold effect was observed exclusively in male patients. Conclusion: This study provides evidence supporting a potential threshold effect between ADG and mortality risk in oral or intravenous glucocorticoid users with secondary pneumonia. Specifically, male patients receiving high-dose glucocorticoids should undergo close monitoring when the ADG of methylprednisolone exceeds 20g, as it may be associated with an elevated risk of mortality.

    Keywords: Glucocorticoids, Pneumonia, Mortality, threshold effect, gender

    Received: 13 Jun 2024; Accepted: 10 Sep 2024.

    Copyright: © 2024 Wang and Ye. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Saibin Wang, Jinhua Municipal Central Hospital, Jinhua, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.