Corticosteroids with mineralocorticoid activity showed no difference in 30-day hospital-free days vs those with minimal activity (23.0 vs 22.8 days; difference 0.3; 95% CI -0.02 to 0.5; p=0.07).
Observational (n=24,162)
Sí
Does initial treatment with mineralocorticoid-containing corticosteroids compared to non-mineralocorticoid-containing corticosteroids improve hospital-free days by day 30 in hospitalized patients with concurrent AECOPD and ADHF?
In patients hospitalized with concurrent AECOPD and ADHF, initial treatment with mineralocorticoid-containing corticosteroids was not associated with fewer hospital-free days or increased mortality compared to non-mineralocorticoid-containing corticosteroids.
Estimación del efecto: difference 0.3 (95% CI -0.02 to 0.5)
Tasa de eventos absoluta: 23% vs 22.8%
valor p: p=0.07
Abstract Background Concurrent acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and acute decompensated heart failure (ADHF) are common among hospitalized patients and may represent up to 40% of AECOPD hospitalizations. Corticosteroids, commonly used to treat AECOPD, that have mineralocorticoid activity can promote fluid retention, potentially worsening ADHF. This study aimed to compare the effectiveness of corticosteroids with mineralocorticoid activity to corticosteroids with minimal mineralocorticoid activity in patients admitted with concurrent AECOPD and ADHF. Methods We utilized the Premier Healthcare Database to identify patients aged 50 years old, who were hospitalized between October 2022 – September 2024 with both AECPOD and ADHF, present on admission. Eligible patients received parenteral loop diuretics as well as systemic corticosteroid on the day of admission. Patients were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes, then classified according to initial corticosteroid use as having mineralocorticoid activity (hydrocortisone/prednisone; CMA) or having minimal mineralocorticoid activity (methylprednisolone/dexamethasone; CMMA) We conducted a target trial emulation. Outcomes were estimated using targeted maximum likelihood estimation with adjustment for patient-and hospital-level covariates. The primary outcome was hospital-free days by day 30. Results Our sample included 24,162 hospitalizations, mean age 72±10 years. Of these, 2,562 (11%) received CMA and 21,600 (89%) received CMMA. There was no difference in our primary outcome of hospital-free days by day 30 (23.0 vs 22.8 days; difference 0.3 95% CI –0.02 to 0.5, p = 0.07; Figure 1) or mortality (5.9% vs 6.2%; difference –0.3 95% CI –1.4 to 0.8, p = 0.6) between patients who received CMA versus those who received CMMA. Patients receiving CMA had fewer days of intravenous diuretic use (3.8 vs 4.0; difference –0.2 95% CI –0.3 to –0.1). Additionally, hospital length of stay was lower in the CMA group (5.7 vs 6.0; difference -0.3 95% CI -0.5 to -0.1. Conclusions In this large, multicenter study of patients hospitalized with concurrent AECOPD and ADHF, initial treatment with CMA was not associated with fewer hospital-free days or increased mortality relative to CMMA. These findings suggest that either corticosteroid class can be used safely in this population, although prospective studies are warranted and further research is needed to explore physiologic mechanisms underlying steroid response. This abstract is funded by: American Heart Association Grant Number 24CDA1267699
Nguyen et al. (Fri,) conducted a observational in Concurrent acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and acute decompensated heart failure (ADHF) (n=24,162). Corticosteroids with mineralocorticoid activity (hydrocortisone/prednisone) vs. Corticosteroids with minimal mineralocorticoid activity (methylprednisolone/dexamethasone) was evaluated on Hospital-free days by day 30 (difference 0.3, 95% CI -0.02 to 0.5, p=0.07). Corticosteroids with mineralocorticoid activity showed no difference in 30-day hospital-free days vs those with minimal activity (23.0 vs 22.8 days; difference 0.3; 95% CI -0.02 to 0.5; p=0.07).