Corticosteroid Use Following the Onset of Invasive Aspergillosis is Associated with Increased Mortality: A Propensity Score-Matched Study

Abstract

Abstract Background: The safety of corticosteroid use (CSU) during active infection is controversial. In the invasive aspergillosis (IA) literature, CSU is typically defined using the time period prior to IA onset. Clinicians caring for patients with IA are unable to control prior CSU. The more clinically relevant question is whether CSU after IA onset is harmful. Methods: Patients hospitalized at our institution from 2004 to 2014 with IA were retrospectively identified. CSU, defined as the average daily prednisone equivalent dose during the 7-day period following IA onset, was calculated for each patient. A CSU cut-off of 7.5mg was used to assign patients to treatment (>7.5mg) or control (<7.5mg, including no CSU) groups. A propensity score (PS) was generated to predict group assignment. Nearest neighbor matching was performed with a caliper width of 0.2. A Cox proportional hazards model was used to assess survival 6 weeks after IA onset. Results: PS matching generated 61 matched pairs (122 patients). Baseline characteristics did not differ significantly between groups (Table). CSU was associated with increased mortality (PS adjusted hazard ratio [HR] 2.91, 95% CI 1.32–6.40). In the CSU group, a trend towards lower mortality was noted if corticosteroid dose was tapered to 7.5mg/day (HR 0.68, 95% CI 0.46–1.02). Conclusion: CSU after IA onset is associated with increased mortality. In IA patients with CSU, efforts to reduce corticosteroid dose may be beneficial. Table: Propensity matched patients at IA Onset CSU (n = 61) Control (n = 61) P Age, years 57.6 (49.2–65.9) 53.2 (42.5–63.2) .27 Male 59.0% (36/61) 54.1% (33/61) .72 CSU >7.5mg prior to IA 78.7% (48/61) 70.5% (43/61) .41 Leukemia 52.5% (32/61) 49.2% (30/61) .86 Allogeneic bone marrow transplant 26.2% (16/61) 29.5% (18/61) .84 Graft vs. host disease 3.3% (2/61) 11.5% (7/61) .16 Neutropenia 48.3% (28/58) 42.9% (24/56) .58 Solid organ transplant 11.5% (7/61) 6.6% (4/61) .53 Obstructive lung disease 21.3% (13/61) 24.6% (15/61) .83 Diabetes mellitus 26.2% (16/61) 29.5% (18/61) .84 Pulmonary IA 94.8% (55/58) 94.9% (56/59) .99 Coinfection 23.0% (14/61) 21.3% (13/61) .99 Data presented as median (interquartile range) or % (n with feature/n with data available) Figure. Kaplan–Meier curves comparing 6-week survival Disclosures All authors: No reported disclosures.