Pelle Trier Petersen, Jacob Bodilsen, Micha Phill Grønholm Jepsen, Lykke Larsen, Merete Storgaard, Birgitte Rønde Hansen, Jannik Helweg-Larsen, Lothar Wiese, Hans Rudolf Lüttichau, Christian Østergaard Andersen, Henrik Nielsen, Christian Thomas Brandt
{"title":"地塞米松在成人病毒性脑膜炎患者中的应用:一项观察性队列研究。","authors":"Pelle Trier Petersen, Jacob Bodilsen, Micha Phill Grønholm Jepsen, Lykke Larsen, Merete Storgaard, Birgitte Rønde Hansen, Jannik Helweg-Larsen, Lothar Wiese, Hans Rudolf Lüttichau, Christian Østergaard Andersen, Henrik Nielsen, Christian Thomas Brandt","doi":"10.1016/j.cmi.2024.08.015","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether there is a dose-dependent association between empiric dexamethasone and outcome in viral meningitis.</p><p><strong>Methods: </strong>Observational cohort study of adults hospitalized for viral meningitis, both with and without a microbiologically confirmed diagnosis, in Denmark between 2015 and 2020. Dose-dependent associations between dexamethasone (one dose = 10 mg) and an unfavourable outcome (Glasgow Outcome Scale score 1-4) at 30 days after discharge were assessed using weighted logistic regression. Entropy balancing was used to compute weights.</p><p><strong>Results: </strong>Of 1025 included patients, 658 (64%) did not receive dexamethasone, 115 (11%) received 1-2 doses, 131 (13%) received 3-4 doses, and 121 (12%) received ≥5 doses. Among patients treated with dexamethasone, the median number of doses was higher for those without an identified pathogen than for those with a microbiologically confirmed viral aetiology (5 [interquartile range (IQR) 3-8] vs. 3 [IQR 2-5]; p < 0.001). Using no doses of dexamethasone as a reference, the weighted OR for an unfavourable outcome were 0.55 (95% CI, 0.29-1.07) for 1-2 doses, 1.13 (95% CI, 0.67-1.89) for 3-4 doses, and 1.43 (95% CI, 0.77-2.64) for ≥5 doses. In the subgroup of enteroviral meningitis, the weighted OR was 3.08 (95% CI, 1.36-6.94) for ≥5 doses, but decreased to 2.35 (95% CI, 0.65-8.40) when the reference group was restricted to patients treated with antibiotics for suspected bacterial meningitis.</p><p><strong>Discussion: </strong>This study showed no dose-dependent association between dexamethasone and an unfavourable outcome in patients with viral meningitis. In enteroviral meningitis, ≥5 doses were associated with an increased risk of an unfavourable outcome. However, sensitivity analysis indicated that the association was affected by unmeasured or residual confounding by severity.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":null,"pages":null},"PeriodicalIF":10.9000,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dexamethasone in adults with viral meningitis: an observational cohort study.\",\"authors\":\"Pelle Trier Petersen, Jacob Bodilsen, Micha Phill Grønholm Jepsen, Lykke Larsen, Merete Storgaard, Birgitte Rønde Hansen, Jannik Helweg-Larsen, Lothar Wiese, Hans Rudolf Lüttichau, Christian Østergaard Andersen, Henrik Nielsen, Christian Thomas Brandt\",\"doi\":\"10.1016/j.cmi.2024.08.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To investigate whether there is a dose-dependent association between empiric dexamethasone and outcome in viral meningitis.</p><p><strong>Methods: </strong>Observational cohort study of adults hospitalized for viral meningitis, both with and without a microbiologically confirmed diagnosis, in Denmark between 2015 and 2020. Dose-dependent associations between dexamethasone (one dose = 10 mg) and an unfavourable outcome (Glasgow Outcome Scale score 1-4) at 30 days after discharge were assessed using weighted logistic regression. Entropy balancing was used to compute weights.</p><p><strong>Results: </strong>Of 1025 included patients, 658 (64%) did not receive dexamethasone, 115 (11%) received 1-2 doses, 131 (13%) received 3-4 doses, and 121 (12%) received ≥5 doses. Among patients treated with dexamethasone, the median number of doses was higher for those without an identified pathogen than for those with a microbiologically confirmed viral aetiology (5 [interquartile range (IQR) 3-8] vs. 3 [IQR 2-5]; p < 0.001). Using no doses of dexamethasone as a reference, the weighted OR for an unfavourable outcome were 0.55 (95% CI, 0.29-1.07) for 1-2 doses, 1.13 (95% CI, 0.67-1.89) for 3-4 doses, and 1.43 (95% CI, 0.77-2.64) for ≥5 doses. In the subgroup of enteroviral meningitis, the weighted OR was 3.08 (95% CI, 1.36-6.94) for ≥5 doses, but decreased to 2.35 (95% CI, 0.65-8.40) when the reference group was restricted to patients treated with antibiotics for suspected bacterial meningitis.</p><p><strong>Discussion: </strong>This study showed no dose-dependent association between dexamethasone and an unfavourable outcome in patients with viral meningitis. In enteroviral meningitis, ≥5 doses were associated with an increased risk of an unfavourable outcome. However, sensitivity analysis indicated that the association was affected by unmeasured or residual confounding by severity.</p>\",\"PeriodicalId\":10444,\"journal\":{\"name\":\"Clinical Microbiology and Infection\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":10.9000,\"publicationDate\":\"2024-08-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Microbiology and Infection\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.cmi.2024.08.015\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Microbiology and Infection","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cmi.2024.08.015","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
目的研究经验性地塞米松与病毒性脑膜炎的治疗效果之间是否存在剂量依赖关系:方法:对2015-2020年间丹麦因病毒性脑膜炎住院的成人进行观察性队列研究,包括经微生物学确诊和未经微生物学确诊的患者。通过加权逻辑回归评估了地塞米松(一次剂量=10毫克)与出院后30天的不良预后(格拉斯哥预后量表评分1-4)之间的剂量依赖关系。计算权重时使用了熵平衡:在纳入的1025名患者中,658人(64%)未使用地塞米松,115人(11%)使用了1-2次,131人(13%)使用了3-4次,121人(12%)使用了≥5次。在接受地塞米松治疗的患者中,未确定病原体的患者的剂量中位数高于经微生物学证实为病毒病因的患者(5 [IQR 3-8] vs 3 [IQR 2-5]; p结论:这项研究表明,地塞米松与病毒性脑膜炎患者的不良预后之间不存在剂量依赖关系。在肠道病毒脑膜炎患者中,≥5 次剂量与不良预后风险增加有关。然而,一项敏感性分析表明,这种关联受到严重程度的未测量或残余混杂因素的影响。
Dexamethasone in adults with viral meningitis: an observational cohort study.
Objectives: To investigate whether there is a dose-dependent association between empiric dexamethasone and outcome in viral meningitis.
Methods: Observational cohort study of adults hospitalized for viral meningitis, both with and without a microbiologically confirmed diagnosis, in Denmark between 2015 and 2020. Dose-dependent associations between dexamethasone (one dose = 10 mg) and an unfavourable outcome (Glasgow Outcome Scale score 1-4) at 30 days after discharge were assessed using weighted logistic regression. Entropy balancing was used to compute weights.
Results: Of 1025 included patients, 658 (64%) did not receive dexamethasone, 115 (11%) received 1-2 doses, 131 (13%) received 3-4 doses, and 121 (12%) received ≥5 doses. Among patients treated with dexamethasone, the median number of doses was higher for those without an identified pathogen than for those with a microbiologically confirmed viral aetiology (5 [interquartile range (IQR) 3-8] vs. 3 [IQR 2-5]; p < 0.001). Using no doses of dexamethasone as a reference, the weighted OR for an unfavourable outcome were 0.55 (95% CI, 0.29-1.07) for 1-2 doses, 1.13 (95% CI, 0.67-1.89) for 3-4 doses, and 1.43 (95% CI, 0.77-2.64) for ≥5 doses. In the subgroup of enteroviral meningitis, the weighted OR was 3.08 (95% CI, 1.36-6.94) for ≥5 doses, but decreased to 2.35 (95% CI, 0.65-8.40) when the reference group was restricted to patients treated with antibiotics for suspected bacterial meningitis.
Discussion: This study showed no dose-dependent association between dexamethasone and an unfavourable outcome in patients with viral meningitis. In enteroviral meningitis, ≥5 doses were associated with an increased risk of an unfavourable outcome. However, sensitivity analysis indicated that the association was affected by unmeasured or residual confounding by severity.
期刊介绍:
Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.