ArticleJournal of thoracic disease2025
Corticosteroid use before ICU admission and 90-day all-cause readmission risk in patients with acute exacerbation of chronic obstructive pulmonary disease: an analysis of the MIMIC-IV database.
Article in Journal of thoracic disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Background: Patients experiencing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) often face poor prognoses and high readmission rates. While corticosteroids play a central role in the management of AECOPD by reducing airway inflammation, improving lung function, and accelerating symptom resolution, their impact on subsequent readmission risk in AECOPD patients remains unclear. This study aimed to explore the relationship between corticosteroid use prior to intensive care unit (ICU) admission and the 90-day all-cause readmission risk in AECOPD patients. Methods: We included 1,219 AECOPD patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. To balance baseline characteristics between groups, we employed inverse probability of treatment weighting (IPTW) based on propensity scores. A multivariate logistic regression model was utilized to assess the association between corticosteroid use and 90-day readmission risk. Subgroup analyses evaluated heterogeneity across different populations, along with a mediation analysis to investigate the role of elevated blood glucose levels. Results: After adjusting for all confounding factors, corticosteroid use before ICU admission was associated with a significantly heightened risk of 90-day readmission in both the original and IPTW-weighted cohorts, with odds ratios of 1.933 [95% confidence interval (CI): 1.400-2.664] and 1.970 (95% CI: 1.417-2.738), respectively. This association remained robust across subgroup analyses. Mediation analysis indicated that elevated blood glucose levels mediated the readmission risk, accounting for 29.7% and 17.4% of the total effect in the original and IPTW cohorts, respectively. Conclusions: Corticosteroid usage before ICU admission is significantly associated with a heightened risk of 90-day readmission in AECOPD patients, partially mediated by elevated blood glucose levels.
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