Original article
High doses of systemic corticosteroids in patients hospitalized for exacerbation of chronic obstructive pulmonary disease. A cohort study
Dosis altas de corticoides sistémicos en pacientes ingresados por exacerbación de enfermedad pulmonar obstructiva crónica. Un estudio de cohortes
J.A. Rueda-Camino
, D. Bernal-Bello, J. Canora-Lebrato, L. Velázquez-Ríos, V. García de Viedma-García, M. Guerrero-Santillán, M.A. Duarte-Millán, R. Cristóbal-Bilbao, A. Zapatero-Gaviria
Corresponding author
Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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A cohort study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "504" "paginaFinal" => "509" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.A. Rueda-Camino, D. Bernal-Bello, J. Canora-Lebrato, L. Velázquez-Ríos, V. García de Viedma-García, M. Guerrero-Santillán, M.A. Duarte-Millán, R. Cristóbal-Bilbao, A. Zapatero-Gaviria" "autores" => array:9 [ 0 => array:4 [ "nombre" => "J.A." "apellidos" => "Rueda-Camino" "email" => array:1 [ 0 => "joseantonio.rueda@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Bernal-Bello" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Canora-Lebrato" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Velázquez-Ríos" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "García de Viedma-García" ] 5 => array:2 [ "nombre" => "M." 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Un estudio de cohortes" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease (COPD) is one of the main causes of morbidity and mortality in developed countries.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> Clinical practice guidelines establish the need to treat patients hospitalized for COPD exacerbation with systemic corticosteroids. The recommended daily regimen is 40<span class="elsevierStyleHsp" style=""></span>mg of prednisone orally for 5 days.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2–4</span></a> However, the clinical audit of patients hospitalized for COPD exacerbation in Spain (AUDIPOC) study showed considerable variability in the actual treatment of these patients.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> An observational study with a large sample size observed no differences between a strategy based on low-dose corticosteroids administered orally and one that used high doses intravenously.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The objective of the present study was to assess, in patients hospitalized for COPD exacerbation, the effect of high-dose corticosteroids on hospital stay, readmission and mortality at 3 months of discharge.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A prospective cohort study was conducted of patients who were consecutively admitted to the departments of internal medicine, pulmonology and intensive care for COPD exacerbation between January and March 2015 in the University Hospital of Fuenlabrada (Madrid, Spain), a center with a reference population in January 2015 of 220,000 inhabitants. The decision for hospitalization depended on the clinical judgment of the team that treated the patients on each occasion. The decision to prescribe systemic corticosteroids, as well as the dosage and treatment duration, depended on the clinical judgment of the physician responsible for the patient. We excluded those patients who were not treated with systemic corticosteroids.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patients’ demographic and clinical data were reviewed retrospectively using the hospital's medical record information manager. The endpoints were the length of hospital stay and the readmissions and mortality during the 3 months following discharge.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To avoid influencing the therapeutic approach during hospitalization, the study monitoring remained blind for the physicians responsible for the hospitalization. Standard clinical practice was not modified by the inclusion of the patient into the study.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We grouped the patients into 2 categories depending on the dose of corticosteroids administered: <40<span class="elsevierStyleHsp" style=""></span>mg or >40<span class="elsevierStyleHsp" style=""></span>mg of prednisone or equivalent. To this end, we designed the variable daily dose (DD) dividing the total dose administered between the days of corticosteroid treatment. We also established 2 groups according to whether the hospital stay was longer or shorter than the median stay.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using the IBM SPSS Statistics 22 software. The quantitative variables are listed using their frequency distribution and were compared using the chi-squared test and Fisher's exact test, as appropriate. The quantitative variables with symmetrical distribution are listed as mean and standard deviation (SD) and were compared with Student's <span class="elsevierStyleItalic">t</span>-test. The asymmetric variables are listed using their median and interquartile range (IQR), establishing the comparisons with the median test.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The univariate data analysis was performed using the calculation of the relative risk (RR) for the median hospital stay and using Cox regression for readmissions and mortality. To determine the presence of effect-modifying and confounding factors, we performed a stratified analysis for variables such as age and those that showed a heterogeneous distribution between the 2 patient categories. A heterogeneous distribution was considered when the differences between the groups were statistically significant or when the <span class="elsevierStyleItalic">p</span> value was >.05 but the difference was clinically relevant in the researchers’ opinion. We then performed a multivariate analysis. The final model included all interactions that reached a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.10 (this <span class="elsevierStyleItalic">p</span> value was selected in anticipation of a small sample size that could affect the statistical power). In the analysis to determine the presence of confounding factors, we considered that each of the mentioned variables acted as such when the adjusted effect changed the unadjusted effect by 10%. For the multivariate analysis, we employed binary logistic regression (for the median hospital stay) or Cox regression (for readmission and mortality). The lost values were not included in the analysis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study was approved by the local clinical research ethics committee (EC854: 15/37). The participants granted their written informed consent, and the study was drafted according to the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) consensus.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">During the study period, a total of 100 patients were admitted for COPD exacerbation. Of these, 13 were excluded for having been treated with systemic corticosteroids. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the patients’ baseline characteristics. The percentage of lost data was less than 1% for all variables, except in the case of forced expiratory volume in one second (FEV1) (14.9%) and obesity (16.1%).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The median DD administered to the patients was 60<span class="elsevierStyleHsp" style=""></span>mg of prednisone (IQR, 46.67–82.33), which was administered intravenously, at least initially, to 84 patients (96.6%). The median systemic corticosteroid treatment in hospital lasted 9 days (IQR, 7–14). Some 18.4% of the participants were treated with a daily dose ≤40<span class="elsevierStyleHsp" style=""></span>mg of prednisone. Some 73.56% of the patients maintained corticosteroid treatment in descending regimen at discharge. Considering the sample as a whole, the mean stay was 8 days (IQR, 8–14). At 3 months of the discharge, 33 patients were readmitted (37.9%) and 9 had died (10.3%). The mean time to readmission was 72 days (SD, ±27<span class="elsevierStyleHsp" style=""></span>days); the mean time to death was 86 days (SD: ±17<span class="elsevierStyleHsp" style=""></span>days). The results of these clinical progression variables in each of the 2 patient groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In the univariate analysis, the patients who were treated with a daily dose of corticosteroids >40<span class="elsevierStyleHsp" style=""></span>mg had a RR of a hospital stay longer than 8 days of 1.095 [confidence interval (95% CI) 0.597–2.007; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.765]. In these patients, the hazard ratio (HR) for readmission and mortality at 3 months was 0.903 (95% CI 0.392–2.082; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.811) and 1.832 (95% CI 0.229–16.645; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.568), respectively.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The stratified analysis for detecting interaction or confounding factors is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. For the interaction analysis, we considered age, hospitalization for exacerbation with pneumonia, arterial hypertension (AHT) and the administration of a descending corticosteroid regimen at discharge. The stratified analysis according to age was performed by dividing the sample at its median (70 years). Given that the descending corticosteroid regimen was prescribed after discharge, we did not stratify the regimen for the hospital stay analysis. Based on the results, none of the interactions were selected for inclusion in the final model.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">With regard to confounding factors, we did not consider any variable in the analysis of the length of stay. In the analysis of readmissions, we only considered AHT (adjusted HR, 0.998). In the analysis of mortality, we included age (adjusted HR, 2.256), hospitalization for exacerbation with pneumonia (adjusted HR, 1.534), AHT (adjusted HR, 2.276) and the descending corticosteroid regimen (adjusted HR, 3.260).</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the multivariate analysis, we included, in addition to the daily dose, all variables that were considered confounding factors. Age was not assessed in the mortality analysis, given that the absence of deaths in those younger than 70 years created a significant bias when adjusting the model. The results are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The present study of patients hospitalized for COPD exacerbation shows a use of systemic corticosteroids at doses and durations greater than those recommended in the clinical practice guidelines. These higher doses do not seem to be associated with a reduction in hospital stay or in the rates of readmission and mortality. The guidelines recommend administering corticosteroids during COPD exacerbation at a dose of 40<span class="elsevierStyleHsp" style=""></span>mg of prednisone orally for 5 days.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2–4</span></a> In this study, however, the doses employed were higher (median daily dose of 60<span class="elsevierStyleHsp" style=""></span>mg), as was the case in another study published by Lindenauer et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The benefit of corticosteroids in COPD exacerbations was shown years ago in 2 clinical trials,<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8,9</span></a> which employed methylprednisolone at a dosage of 0.5<span class="elsevierStyleHsp" style=""></span>mg/kg/6<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> and 500<span class="elsevierStyleHsp" style=""></span>mg/day,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> respectively. Similar results were subsequently reported with significantly lower dosages.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">10–13</span></a> These studies were evaluated in a meta-analysis in 2008 by Quon et al.,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> in which the use of systemic corticosteroids was related to reductions in hospital stays, reduced symptoms and improved obstruction parameters in the spirometry.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Almost all patients included in the present study were treated with corticosteroids intravenously, at least initially, which also differs from the guidelines’ recommendations.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2–4</span></a> De Jong et al.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> observed no differences in safety and efficacy between oral and intravenous administration. Significant differences have also not been observed between low doses administered orally and higher doses administered intravenously.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The corticosteroid treatment duration in our study (median of 9 days) was also longer than recommended (5 days). In the Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) trial, the benefit of treatment with 40<span class="elsevierStyleHsp" style=""></span>mg of prednisone for 5 days did not differ from that observed with 14 days.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> The 5-day regimen is also supported by other publications.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">17,18</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Unlike other research studies,<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6,18</span></a> our study did not exclude patients with exacerbated COPD and pneumonia. Considering that pneumonia can represent a condition of greater severity, the results suggest that higher doses of corticosteroids do not provide greater benefits, even for patients with more severe disease. Nevertheless, 2 recent meta-analyses suggested a benefit of corticosteroids in treating community-acquired pneumonia.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">19,20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">According to the available information, this study is the only one published to date in our setting on the use of systemic corticosteroids in patients hospitalized for COPD exacerbation. In the AUDIPOC study, performed in 129 Spanish hospitals, the results in terms of the baseline and evolutionary characteristics of more than 5000 included patients were similar to those of our study population.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> However, detailed information on the use of systemic corticosteroids was not provided.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The study has a number of limitations, including the small sample size, which resulted in a lack of statistical significance in some of the estimates. The single center origin of the patients limited the generalization of the results, although the data from other cohorts are similar to ours.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> It is important to note that information was not obtained from patients excluded for not receiving systemic corticosteroids (13%). Moreover, this study can offer only a partial view of the problem, because less severe cases treated in the outpatient setting were not assessed. Lastly, we did not analyze the safety variables of the corticosteroids, such as hyperglycemia, infections and onset and worsening of AHT, which in previous studies were observed more frequently in the patient group treated with higher doses of corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In conclusion, this study does not support the use of high doses of corticosteroids in patients hospitalized for COPD exacerbation.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres947395" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec919877" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres947396" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec919876" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-12" "fechaAceptado" => "2017-07-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec919877" "palabras" => array:4 [ 0 => "Chronic obstructive pulmonary disease" 1 => "Hospitalization" 2 => "Glucocorticoids" 3 => "Mortality" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec919876" "palabras" => array:4 [ 0 => "Enfermedad pulmonar obstructiva crónica" 1 => "Hospitalización" 2 => "Glucocorticoides" 3 => "Mortalidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the effect of high doses of corticosteroids in patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective cohort study was conducted on patients hospitalized with COPD between January and March 2015, grouped according to the glucocorticoid dosage administered (cutoff, 40<span class="elsevierStyleHsp" style=""></span>mg of prednisone/day). We compared the results of hospital stay, readmission and mortality at 3 months of discharge.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We analyzed 87 patients. The median daily dose was 60<span class="elsevierStyleHsp" style=""></span>mg of prednisone (interquartile range, 46.67–82.33<span class="elsevierStyleHsp" style=""></span>mg/day), and the administration route was intravenous in 96.6% of the cases. We established a relative risk (RR) for hospital stays longer than 8 days of 1.095 (95% CI 0.597–2.007; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.765) when steroid dosages greater than 40<span class="elsevierStyleHsp" style=""></span>mg/day were employed. In these patients, the hazard ratio (HR) for readmission in the 3 months after discharge was 0.903 (95% CI 0.392–2.082; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.811), and the mortality was 1.832 (95% CI 0.229–16.645; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.568). Neither the RR nor the HR varied in a statistically significant manner after adjusting for confounding factors.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A daily dose greater than 40<span class="elsevierStyleHsp" style=""></span>mg of prednisone in patients hospitalized for COPD exacerbation was not associated with a shorter hospital stay or a reduction in readmissions or mortality at 3 months.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar el efecto de las dosis altas de corticoides en pacientes ingresados por exacerbación de una enfermedad pulmonar obstructiva crónica (EPOC).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo de enfermos hospitalizados con EPOC entre enero y marzo de 2015, agrupados en función de la dosis de glucocorticoides recibida (punto de corte: 40<span class="elsevierStyleHsp" style=""></span>mg de prednisona/día). Se compararon los resultados de estancia hospitalaria, y de reingreso y mortalidad a los 3 meses del alta.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 87 pacientes. La mediana de la dosis diaria recibida fue de 60<span class="elsevierStyleHsp" style=""></span>mg de prednisona/día (rango intercuartílico: 46,67-82,33<span class="elsevierStyleHsp" style=""></span>mg/día); la vía de administración fue endovenosa en el 96,6% de los casos. Se estableció un riesgo relativo (RR) de estancia superior a 8 días de 1,095 [intervalo de confianza (IC) 95%: 0,597-2,007; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,765] cuando se usaban dosis de esteroides superiores a 40<span class="elsevierStyleHsp" style=""></span>mg/día. Además, en estos pacientes la <span class="elsevierStyleItalic">hazard ratio</span> (HR) para el reingreso durante los 3 meses siguientes al alta fue de 0,903 [IC 95%: 0,392-2,082; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,811] y la mortalidad de 1,832 [IC 95%: 0,229-16,645; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,568]. Ni el RR ni las HR observadas variaron de forma estadísticamente significativa tras el ajuste por factores de confusión.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Una dosis superior a 40<span class="elsevierStyleHsp" style=""></span>mg diarios de prednisona en pacientes ingresados por exacerbación de EPOC no se asocia a una menor estancia hospitalaria ni a una disminución del reingreso y de la mortalidad a los 3 meses.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Please cite this article as: Rueda-Camino JA, Bernal-Bello D, Canora-Lebrato J, Velázquez-Ríos L, García de Viedma-García V, Guerrero-Santillán M, et al. Dosis altas de corticoides sistémicos en pacientes ingresados por exacerbación de enfermedad pulmonar obstructiva crónica. Un estudio de cohortes. Rev Clin Esp. 2017;217:504–509.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The variables are expressed as percentages (number of positives cases/total number of cases evaluated), mean (standard deviation) or median (interquartile range).</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">FEV1, maximum forced expiratory volume in the first second.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prednisone or equivalent >40<span class="elsevierStyleHsp" style=""></span>mg (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>71) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prednisone or equivalent ≤40<span class="elsevierStyleHsp" style=""></span>mg (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.7 (63/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.5 (14/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.5 (65/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.8 (15/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (10.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.579 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV1, % of theoretical<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.782 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Exacerbation and pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.4 (23/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (8/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.184 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sleep apnea-hypopnea syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.9 (12/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (4/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.481 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.4 (43/70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.3 (13/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.133 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.4 (22/70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3 (5/15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.8 (26/58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (6/15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.737 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3 (8/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.8 (3/13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.417 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous isolation of multiresistant microorganisms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.7 (26/69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (6/15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.867 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lung cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3 (8/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 (1/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anxiety \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.1 (10/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 (1/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.681 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Depression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.5 (6/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.5 (2/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.636 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Corticosteroid therapy duration, days<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (7–14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (6.75–14.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.962 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Descending regimen at discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.5 (55/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.3 (9/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.116 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1604524.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The values correspond to the mean (standard deviation).</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The values correspond to the median (interquartile range).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Baseline patient characteristics.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Length of stay, days<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Length of stay >8 days<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Readmission<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time to readmission, days<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Death<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time to death, days<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prednisone or equivalent >40<span class="elsevierStyleHsp" style=""></span>mg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (6–14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.9 (34/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.6 (26/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3 (8/71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 (11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prednisone or equivalent ≤40<span class="elsevierStyleHsp" style=""></span>mg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (7–11.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.8 (7/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.8 (7/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 (1/16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 (15) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1604527.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">The values correspond to the median (interquartile range).</p>" ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">The values correspond to the percentage (number of positive cases/total number of evaluated cases).</p>" ] 2 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">The values correspond to the mean (standard deviation).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Hospital stay and readmissions and mortality rates at 3 months of discharge, according to the dosage of systemic corticosteroids.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CI, confidence interval; HR, hazard ratio; RR, relative risk; <span class="elsevierStyleItalic">p</span> of the interaction.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Length of stay >8 days, RR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Readmission at 3 months, HR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Death at 3 months, HR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Age</td><td class="td" title="table-entry " align="left" valign="top">Over 70 years of age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.818 (0.469–1.428) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.150</td><td class="td" title="table-entry " align="left" valign="top">0.731 (0.256–2.082) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.533</td><td class="td" title="table-entry " align="left" valign="top">2.256 (0.282–18.039) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.996</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">70 years or younger \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.947 (0.462–18.791) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.397 (0.317–6.151) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Hospitalization for pneumonia</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.957 (0.424–2.159) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.598</td><td class="td" title="table-entry " align="left" valign="top">0.923 (0.290–3.072) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.917</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.959</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.278 (0.498–3.278) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.937 (0.279–3.247) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.230 (0.151–10.003) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Arterial hypertension</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.008 (0.516–1.967) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.546</td><td class="td" title="table-entry " align="left" valign="top">0.996 (0.395–2.512) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.956</td><td class="td" title="table-entry " align="left" valign="top">2.156 (0.265–17.526) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.966</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.444 (0.278–7.502) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.961 (0.120–7.699) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Descending corticosteroid regimen</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top"></td><td class="td" title="table-entry " align="left" valign="top">1.302 (0.389–4.352) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.277</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">.958</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.493 (0.123–1.981) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.898 (0.348–24.106) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1604526.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">The analysis could not be performed due to lack of cases.</p>" ] 1 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">The model could not be adjusted due to the low number of cases.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Stratified analysis of the hospital stay and readmission and mortality at 3 months of discharge.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">CI, confidence interval; HR, hazard ratio; RR, relative risk.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Length of stay >8<span class="elsevierStyleHsp" style=""></span>days, RR (95% CI), <span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Readmission, HR (95% CI), <span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Death, HR (95% CI), <span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Univariate analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.095 (0.597–2.007), .765 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.903 (0.392–2.082), .811 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.832 (0.229–14.645), .568 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Multivariate analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.095 (0.597–2.007), .765 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.998 (0.428–2.327), .998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.739 (0.312–24.035), .363 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1604525.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0040">The included variable was the daily dose of corticosteroids.</p>" ] 1 => array:3 [ "identificador" => "tblfn0045" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0045">The included variables were the daily dose of corticosteroids and arterial hypertension.</p>" ] 2 => array:3 [ "identificador" => "tblfn0050" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0050">The included variables were the daily dose of corticosteroids, hospitalization for pneumonia, arterial hypertension and the descending corticosteroid regimen at discharge.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Univariate and multivariate analysis of the hospital stay and readmission and mortality at 3 months of discharge.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New treatments for chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. 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| 2023 March | 10 | 4 | 14 |
| 2017 December | 2 | 0 | 2 |
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