Association Between Systemic Corticosteroid Use and Mortality in Patients with Epiglottitis

Objectives To clarify whether treatment with systemic corticosteroids at a certain dose was associated with better outcomes in patients with epiglottitis requiring airway management (tracheotomy or airway intubation). Methods This was a retrospective cohort study on patients hospitalized for epiglottitis requiring airway management from a nationwide inpatient database (between July 2010 and March 2019). Patients treated with systemic corticosteroids equivalent to methylprednisolone ≥40 mg/d within 2 days of admission and patients who were not treated with corticosteroids within 2 days of admission were compared after inverse probability of treatment weighting using covariate balancing propensity score. The primary outcome was all‐cause 30‐day in‐hospital mortality, and secondary outcomes included all‐cause 7‐day in‐hospital mortality, length of hospital stay, and total medical cost. Results There were 1986 and 1771 patients in the corticosteroid and control groups, respectively. A total of 72 of 3757 (1.9%) patients died within 30 days of admission, including 17 of 1986 (0.9%) patients in the corticosteroid group and 55 of 1771 (3.1%) in the control group (weighted odds ratio, 0.28 [95% confidence interval, 0.11–0.70]; weighted risk difference, −2.2% [−3.2% to −1.3%]). Treatment with corticosteroids was associated with lower total medical costs (weighted median, $6,187 vs. $6,587; weighted difference, $‐1,123 [−2,238 to −8]) but not all‐cause 7‐day in‐hospital mortality (weighted odds ratio, 0.63 [0.22–1.82]; weighted risk difference, −0.3% [−0.9 to 0.2]) and length of hospital stay (weighted median, 13 vs. 13 days; weighted difference, −0.2 days [−2.1 to 1.8]). Conclusions Systemic corticosteroids may be beneficial to patients with epiglottitis requiring airway management. Level of Evidence 3 Laryngoscope, 133:344–349, 2023