Short term steroids may be associated with sepsis, thrombosis and fractures

Goodfellow Gems Logo

Goodfellow Gems

Short term steroids may be associated with sepsis, thrombosis and fractures  

A US cohort study of 1,548,945 adults 18 to 64 years, compared those who had less than 30 days of oral corticosteroids and their harms, measured over the subsequent 90 days.1  

The numbers needed to harm for sepsis (defined as requiring hospitalisation) was 3,333, to get a venous thromboembolism 2,000 and a fracture 833. 21% of patients received such a course of oral corticosteroids over the 3 years of the study. While these risks are low this is a young population of insured adults with few comorbidities. 

The analysis controlled for many medications including NSAIDs, antiplatelet drugs, antibiotics and COX-2 inhibitors. The median doses for sepsis, thromboembolism and fracture were 20 mg of prednisone per day, 17.5 mg and 19 mg respectively. The equivalent median duration was 6 days. 

It may be worth advising patients taking prednisone for short courses to avoid jogging or contact sports to help avoid fractures. Perhaps we should alert them to the possibility of sepsis and blood clots.

Reference

  1. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ 2017.  Click here 

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.



  
As published in NZ Doctor 11/10/2017