Corticosteroids may improve clinical outcomes during hospitalization for Henoch-Schönlein purpura

Abstract

Objective: To characterize the effect of corticosteroid exposure on clinical outcomes in children hospitalized with new-onset Henoch-Schönlein purpura (HSP).

Patients and methods: We conducted a retrospective cohort study of children discharged with an International Classification of Diseases, Clinical Modification code of HSP between 2000 and 2007 by using inpatient administrative data from 36 tertiary care children's hospitals. We used stratified Cox proportional hazards regression models to estimate the relative effect of time-varying corticosteroid exposure on the risks of clinical outcomes that occur during hospitalization for acute HSP.

Results: During the 8-year study period, there were 1895 hospitalizations for new-onset HSP. After multivariable regression modeling adjustment, early corticosteroid exposure significantly reduced the hazard ratios for abdominal surgery (0.39 [95% confidence interval (CI): 0.17-0.91]), endoscopy (0.27 [95% CI: 0.13-0.55]), and abdominal imaging (0.50 [95% CI: 0.29-0.88]) during hospitalization.

Conclusions: In the hospital setting, early corticosteroid exposure was associated with benefits for several clinically relevant HSP outcomes, specifically those related to the gastrointestinal manifestations of the disease.

FIGURE 1

Corticosteroid use and early-period resource utilization. Corticosteroid use was defined as initial exposure to corticosteroids on day 1 or 2 of hospitalization. Hospital charges on days 1 to 2 are used as a proxy for admission severity. Hospital charges were log-transformed and then normalized for admitting hospital. CS indicates corticosteroids.

FIGURE 2

Clinical outcomes in corticosteroid-exposed and -unexposed subjects. Only the first 10 days of hospitalization are graphically represented, because 10 days was the 95th percentile for length of initial hospitalization. A, Surgery; B, endoscopy; C, parenteral nutrition; D, abdominal imaging. CS indicates corticosteroids; early CS, initial corticosteroid exposure on hospital day 1 or 2.

FIGURE 3

Initiation of NSAIDs (A), opioids (B), and antihypertensive agents (C) in corticosteroid-exposed and -unexposed subjects. Only the first 10 days of hospitalization are graphically represented, because 10 days was the 95th percentile for length of initial hospitalization. CS indicates corticosteroids; early CS, initial corticosteroid exposure on hospital day 1 or 2.