Risk of pneumonia and all-cause mortality in outpatients with chronic obstructive pulmonary disease treated with short versus long course of corticosteroids during 3 years of follow-up: A population-based nationwide cohort study

Pradeesh Sivapalan; Rikke  Sørensen; Truls Sylvan Ingebrigtsen; Daniel  Bech Rasmussen; Christian Madelaire; Camilla Bjørn Jensen; Kristine Højgaard Allin; Josefin Eklöf; Niels Seersholm; Jorgen Vestbo; Jens-Ulrik  Stæhr Jensen

Risk of pneumonia and all-cause mortality in outpatients with chronic obstructive pulmonary disease treated with short versus long course of corticosteroids during 3 years of follow-up: A population-based nationwide cohort study

Pradeesh Sivapalan, Rikke Sørensen , Truls Sylvan Ingebrigtsen , Daniel Bech Rasmussen , Christian Madelaire, Camilla Bjørn Jensen , Kristine Højgaard Allin , Josefin Eklöf , Niels Seersholm, Jorgen Vestbo, Jens-Ulrik Stæhr Jensen

Division of Immunology, Immunity to Infection and Respiratory Medicine

Copenhagen University Hospital

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: To examine the impact of oral corticosteroids (OCS) recommendations change, with respect to acute exacerbation of chronic obstructive pulmonary disease (COPD) on risk of pneumonia hospitalisation and all-cause mortality in a nationwide cohort study.Design: Observational cohort study.Setting: A nationwide cohort study based on linked administrative registry data was used.Participants: Outpatients with COPD (n = 10,141) treated with either a short or long course of OCS for acute exacerbations were included in the study. Cox proportional hazard regression models were used to derive an estimation of multivariable adjusted hazard ratios (HRs) for pneumonia hospitalisation and all-cause mortality. As part of the sensitivity analysis, conditional logistic regression was used to estimate odds ratio (OR) of pneumonia.Main outcome measures: Primary outcomes were pneumonia hospitalisation or all-cause mortality combined, and pneumonia hospitalisation and all-cause mortality separately.Results: Long course of OCS treatment (> 250 mg) for acute exacerbation of COPD was associated with an increased 3-year risk of pneumonia hospitalisation or all-cause mortality (adjusted HR 1.3, 95% CI 1.2 to 1.4 , p-value < 0.0001), pneumonia hospitalisation (adjusted HR 1.2, 95% CI 1.1 to 1.3, p-value 0.0014), and all-cause mortality (adjusted HR 1.6, 95% CI 1.0 to 1.8, p-value <.0001) as compared with short-course of OCS treatment (≤ 250 mg). These results were confirmed in several sensitivity analyses, among these a nested case-control analysis.Conclusion: The change of recommendations from long courses to short courses of OCS for acute exacerbations of COPD in 2014 led to a significant decrease in pneumonia admissions and all-cause mortality in this nationwide cohort study, both as combined and separate endpoints, in favor of short courses of OCS.

Original language	English
Journal	BMJ Open Respiratory Research
Publication status	Accepted/In press - 5 Mar 2019

Keywords

OCS
Corticosteroids
Chronic obstructive pulmonary disease
Pneumonia hospitalisation
Mortality
Prednisolone
COPD
Exacerbation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Sivapalan, P., Sørensen , R., Sylvan Ingebrigtsen , T., Bech Rasmussen , D., Madelaire, C., Bjørn Jensen , C., Højgaard Allin , K., Eklöf , J., Seersholm, N., Vestbo, J., & Stæhr Jensen , J.-U. (Accepted/In press). Risk of pneumonia and all-cause mortality in outpatients with chronic obstructive pulmonary disease treated with short versus long course of corticosteroids during 3 years of follow-up: A population-based nationwide cohort study. BMJ Open Respiratory Research.

@article{7c8d11c2645f46b89f1868f428625036,

title = "Risk of pneumonia and all-cause mortality in outpatients with chronic obstructive pulmonary disease treated with short versus long course of corticosteroids during 3 years of follow-up: A population-based nationwide cohort study",

abstract = "Objectives: To examine the impact of oral corticosteroids (OCS) recommendations change, with respect to acute exacerbation of chronic obstructive pulmonary disease (COPD) on risk of pneumonia hospitalisation and all-cause mortality in a nationwide cohort study.Design: Observational cohort study.Setting: A nationwide cohort study based on linked administrative registry data was used.Participants: Outpatients with COPD (n = 10,141) treated with either a short or long course of OCS for acute exacerbations were included in the study. Cox proportional hazard regression models were used to derive an estimation of multivariable adjusted hazard ratios (HRs) for pneumonia hospitalisation and all-cause mortality. As part of the sensitivity analysis, conditional logistic regression was used to estimate odds ratio (OR) of pneumonia.Main outcome measures: Primary outcomes were pneumonia hospitalisation or all-cause mortality combined, and pneumonia hospitalisation and all-cause mortality separately.Results: Long course of OCS treatment (> 250 mg) for acute exacerbation of COPD was associated with an increased 3-year risk of pneumonia hospitalisation or all-cause mortality (adjusted HR 1.3, 95% CI 1.2 to 1.4 , p-value < 0.0001), pneumonia hospitalisation (adjusted HR 1.2, 95% CI 1.1 to 1.3, p-value 0.0014), and all-cause mortality (adjusted HR 1.6, 95% CI 1.0 to 1.8, p-value <.0001) as compared with short-course of OCS treatment (≤ 250 mg). These results were confirmed in several sensitivity analyses, among these a nested case-control analysis.Conclusion: The change of recommendations from long courses to short courses of OCS for acute exacerbations of COPD in 2014 led to a significant decrease in pneumonia admissions and all-cause mortality in this nationwide cohort study, both as combined and separate endpoints, in favor of short courses of OCS. ",

keywords = "OCS, Corticosteroids, Chronic obstructive pulmonary disease, Pneumonia hospitalisation, Mortality, Prednisolone, COPD, Exacerbation",

author = "Pradeesh Sivapalan and Rikke S{\o}rensen and {Sylvan Ingebrigtsen}, Truls and {Bech Rasmussen}, Daniel and Christian Madelaire and {Bj{\o}rn Jensen}, Camilla and {H{\o}jgaard Allin}, Kristine and Josefin Ekl{\"o}f and Niels Seersholm and Jorgen Vestbo and {St{\ae}hr Jensen}, Jens-Ulrik",

year = "2019",

month = mar,

day = "5",

language = "English",

journal = "BMJ Open Respiratory Research",

issn = "2052-4439",

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Sivapalan, P, Sørensen , R, Sylvan Ingebrigtsen , T, Bech Rasmussen , D, Madelaire, C, Bjørn Jensen , C, Højgaard Allin , K, Eklöf , J, Seersholm, N, Vestbo, J & Stæhr Jensen , J-U 2019, 'Risk of pneumonia and all-cause mortality in outpatients with chronic obstructive pulmonary disease treated with short versus long course of corticosteroids during 3 years of follow-up: A population-based nationwide cohort study', BMJ Open Respiratory Research.

Risk of pneumonia and all-cause mortality in outpatients with chronic obstructive pulmonary disease treated with short versus long course of corticosteroids during 3 years of follow-up: A population-based nationwide cohort study. / Sivapalan, Pradeesh; Sørensen , Rikke ; Sylvan Ingebrigtsen , Truls et al.
In: BMJ Open Respiratory Research, 05.03.2019.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Risk of pneumonia and all-cause mortality in outpatients with chronic obstructive pulmonary disease treated with short versus long course of corticosteroids during 3 years of follow-up

T2 - A population-based nationwide cohort study

AU - Sivapalan, Pradeesh

AU - Sørensen , Rikke

AU - Sylvan Ingebrigtsen , Truls

AU - Bech Rasmussen , Daniel

AU - Madelaire, Christian

AU - Bjørn Jensen , Camilla

AU - Højgaard Allin , Kristine

AU - Eklöf , Josefin

AU - Seersholm, Niels

AU - Vestbo, Jorgen

AU - Stæhr Jensen , Jens-Ulrik

PY - 2019/3/5

Y1 - 2019/3/5

N2 - Objectives: To examine the impact of oral corticosteroids (OCS) recommendations change, with respect to acute exacerbation of chronic obstructive pulmonary disease (COPD) on risk of pneumonia hospitalisation and all-cause mortality in a nationwide cohort study.Design: Observational cohort study.Setting: A nationwide cohort study based on linked administrative registry data was used.Participants: Outpatients with COPD (n = 10,141) treated with either a short or long course of OCS for acute exacerbations were included in the study. Cox proportional hazard regression models were used to derive an estimation of multivariable adjusted hazard ratios (HRs) for pneumonia hospitalisation and all-cause mortality. As part of the sensitivity analysis, conditional logistic regression was used to estimate odds ratio (OR) of pneumonia.Main outcome measures: Primary outcomes were pneumonia hospitalisation or all-cause mortality combined, and pneumonia hospitalisation and all-cause mortality separately.Results: Long course of OCS treatment (> 250 mg) for acute exacerbation of COPD was associated with an increased 3-year risk of pneumonia hospitalisation or all-cause mortality (adjusted HR 1.3, 95% CI 1.2 to 1.4 , p-value < 0.0001), pneumonia hospitalisation (adjusted HR 1.2, 95% CI 1.1 to 1.3, p-value 0.0014), and all-cause mortality (adjusted HR 1.6, 95% CI 1.0 to 1.8, p-value <.0001) as compared with short-course of OCS treatment (≤ 250 mg). These results were confirmed in several sensitivity analyses, among these a nested case-control analysis.Conclusion: The change of recommendations from long courses to short courses of OCS for acute exacerbations of COPD in 2014 led to a significant decrease in pneumonia admissions and all-cause mortality in this nationwide cohort study, both as combined and separate endpoints, in favor of short courses of OCS.

AB - Objectives: To examine the impact of oral corticosteroids (OCS) recommendations change, with respect to acute exacerbation of chronic obstructive pulmonary disease (COPD) on risk of pneumonia hospitalisation and all-cause mortality in a nationwide cohort study.Design: Observational cohort study.Setting: A nationwide cohort study based on linked administrative registry data was used.Participants: Outpatients with COPD (n = 10,141) treated with either a short or long course of OCS for acute exacerbations were included in the study. Cox proportional hazard regression models were used to derive an estimation of multivariable adjusted hazard ratios (HRs) for pneumonia hospitalisation and all-cause mortality. As part of the sensitivity analysis, conditional logistic regression was used to estimate odds ratio (OR) of pneumonia.Main outcome measures: Primary outcomes were pneumonia hospitalisation or all-cause mortality combined, and pneumonia hospitalisation and all-cause mortality separately.Results: Long course of OCS treatment (> 250 mg) for acute exacerbation of COPD was associated with an increased 3-year risk of pneumonia hospitalisation or all-cause mortality (adjusted HR 1.3, 95% CI 1.2 to 1.4 , p-value < 0.0001), pneumonia hospitalisation (adjusted HR 1.2, 95% CI 1.1 to 1.3, p-value 0.0014), and all-cause mortality (adjusted HR 1.6, 95% CI 1.0 to 1.8, p-value <.0001) as compared with short-course of OCS treatment (≤ 250 mg). These results were confirmed in several sensitivity analyses, among these a nested case-control analysis.Conclusion: The change of recommendations from long courses to short courses of OCS for acute exacerbations of COPD in 2014 led to a significant decrease in pneumonia admissions and all-cause mortality in this nationwide cohort study, both as combined and separate endpoints, in favor of short courses of OCS.

KW - OCS

KW - Corticosteroids

KW - Chronic obstructive pulmonary disease

KW - Pneumonia hospitalisation

KW - Mortality

KW - Prednisolone

KW - COPD

KW - Exacerbation

M3 - Article

SN - 2052-4439

JO - BMJ Open Respiratory Research

JF - BMJ Open Respiratory Research

ER -

Sivapalan P, Sørensen R, Sylvan Ingebrigtsen T, Bech Rasmussen D, Madelaire C, Bjørn Jensen C et al. Risk of pneumonia and all-cause mortality in outpatients with chronic obstructive pulmonary disease treated with short versus long course of corticosteroids during 3 years of follow-up: A population-based nationwide cohort study. BMJ Open Respiratory Research. 2019 Mar 5.