1777. Corticosteroid Use Following the Onset of Invasive Aspergillosis is Associated with Increased Mortality: A Propensity Score-Matched Study
Session: Oral Abstract Session: The Fungus Among-us - Clinical Advances
Saturday, October 7, 2017: 9:09 AM
Room: 01AB

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 2004-2014 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 cutoff of 7.5 mg was used to assign patients to treatment (>7.5 mg) or control (<7.5 mg, 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 <7.5 mg/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 >7.5 mg 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

Michael Abers, MD, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA and Jatin Vyas, MD, PhD, FIDSA, Medicine; Infectious Disease, Massachusetts General Hospital, Boston, MA

Disclosures:

M. Abers, None

J. Vyas, None

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