Objective: This study aimed to investigate the clinical value of glucocorticoids in patients with neutropenic severe pneumonia at moderate to high risk according to the Pneumonia Severity Index (PSI) in patients with hematologic diseases. Methods: Clinical data were collected from 534 patients at the Fujian Medical University Union Hospital from October 2016 to December 2018. We evaluated the changes in inflammatory cytokines, treatment failure, in-hospital mortality, and other outcomes, adjusting for potential confounders through propensity score matching. Results: Patients were categorized into glucocorticoids (n=176) and control (n=358) groups. The glucocorticoid group demonstrated higher levels of C-reactive protein, procalcitonin, and interleukin-6, alongside higher PSI scores. The differences in comorbidities diminished, except for inflammatory cytokine levels, with a notable reduction in inflammatory cytokines observed in the glucocorticoid group, after matching 125 pairs based on propensity scores. Late treatment failure was more prevalent in the glucocorticoid group (39.2% vs 24.8%, P=0.015), but this was primarily caused by radiographic progression. The incidences of respiratory failure, mechanical ventilation, and septic shock were similar between the groups. Logistic regression analyses revealed that glucocorticoids reduced the risk of treatment failure (OR=0.367, 95% CI 0.165-0.818, P=0.014). The 30-day in-hospital mortality rates were comparable (8.0% in glucocorticoids vs 7.2% in controls, P=0.811), with indications that glucocorticoids may exert a protective effect on mortality. The PSI score was determined as the sole independent risk factor for 30-day in-hospital mortality (OR=1.077, 95% CI 1.032-1.123, P=0.001). No evidence indicated that glucocorticoids increased the incidence of hyperglycemia, gastrointestinal bleeding, or 30-day infection recurrence. Conclusion: Glucocorticoids reduce inflammatory cytokine levels and are potentially related to decreased treatment failure and mortality in patients with neutropenic pneumonia classified as PSI Ⅳ and Ⅴ among hematological patients.
目的： 探索糖皮质激素在血液病患者粒细胞缺乏（粒缺）合并肺炎严重指数（pneumonia severity index，PSI）中高危肺炎中的治疗价值。 方法： 回顾性分析2016年10月1日至2018年12月31日福建医科大学附属协和医院血液科收治的粒缺合并PSI中高危肺炎的534例血液病患者资料，利用倾向性评分（PSM）调整激素组与非激素组之间基础资料的差异，比较两组患者治疗过程中炎症因子的变化，治疗失败率、死亡率、到达临床稳定状态时间、抗菌药物使用天数及不良反应发生率。 结果： 176例患者接受了激素治疗，而358例患者未使用激素。激素组患者炎症因子水平、合并症比例及PSI评分更高。PSM共匹配125对病例。匹配后激素组和非激素组之间的合并症差异减小，但激素组的炎症因子水平仍然较高，接受激素治疗的患者病情较重，而在后续的治疗过程中炎症因子水平的下降更为显著。激素组晚期治疗失败率高于非激素组（39.2%对24.8%，P=0.015），但主要体现在影像学进展，而呼吸衰竭、机械通气、脓毒性休克等严重并发症的发生率差异无统计学意义。Logistic回归分析显示，糖皮质激素可降低治疗失败率（OR=0.367，95%CI 0.165~0.818，P=0.014）。PSI评分高增加治疗失败率（OR=1.028，95%CI 1.007~1.049，P=0.008）。激素组与非激素组30 d死亡率差异无统计学意义（8.0%对7.2%，P=0.811）。PSI评分是30 d死亡的危险因素（OR=1.077，95%CI 1.032~1.123，P=0.001）。激素组PSI Ⅴ级患者30 d生存率与PSI Ⅳ级患者比较差异无统计学意义[（87.8±5.1）%对（94.0±2.6）%，P=0.216]。糖皮质激素并不增加血糖升高、消化道出血和30 d内再感染发生率。 结论： 糖皮质激素在血液病患者粒缺合并PSI中高危肺炎的治疗中有助于控制炎症因子水平，可降低PSI Ⅴ级患者治疗失败率及死亡率。.
Keywords: Glucocorticoids; Neutropenia; Pneumonia severity index; Severe pneumonia.