10.3389/fpsyg.2012.00132

Vollständiger Abstract

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<h4>Background</h4>Older adults hospitalized with community-acquired pneumonia (CAP) often recover slowly despite standard care. Chaihu Guizhi Tang combined with Maxing Shigan Tang (CHGZ + MXSG) is used as adjunctive traditional Chinese medicine for respiratory infections, but prospective evidence in older inpatients is limited. We evaluated its association with short-term clinical recovery.<h4>Methods</h4>In this open-label prospective non-randomized controlled study, 186 older adults hospitalized with CAP received adjunctive CHGZ + MXSG plus standard care (<i>n</i> = 93) or standard care alone (<i>n</i> = 93) after eligibility confirmation, clinical assessment, and clinician-patient discussion. The primary outcome was day-7 clinical cure. Secondary outcomes included 72-h clinical response, time to clinical stability, antibiotic escalation, treatment failure, length of stay, CRP and symptom-score changes, 28-day readmission and mortality, and prespecified treatment-emergent safety events. Multivariable, expanded covariate-adjusted, propensity-score weighting/matching, and follow-up sensitivity analyses were performed.<h4>Results</h4>Day-7 clinical cure occurred in 74 of 93 participants (79.6%) in the CHGZ + MXSG group and 58 of 93 participants (62.4%) in the standard-care group [unadjusted risk ratio 1.28, 95% confidence interval (CI) 1.06 to 1.54; <i>P</i> = 0.010). The CHGZ + MXSG group also had earlier clinical response at 72 h, less antibiotic escalation, shorter mean time to clinical stability, shorter hospital stay, greater CRP reduction by day 5, and greater symptom-score reduction by day 7. In the multivariable-adjusted model, CHGZ + MXSG was associated with higher odds of day-7 clinical cure [odds ratio (OR) 2.37, 95% CI 1.18-4.90], earlier clinical stability [hazard ratio (HR) 1.73, 95% CI 1.27-2.35], and shorter hospital stay (beta -0.99 days, 95% CI -1.49 to -0.49). These findings were directionally consistent across expanded covariate-adjusted analyses, stabilized inverse probability of treatment weighting, trimmed weighting, overlap weighting, 1:1 propensity-score matching, and follow-up sensitivity analyses.<h4>Conclusion</h4>Among hospitalized older adults with CAP, adjunctive CHGZ + MXSG plus standard care was associated with faster short-term clinical recovery and no descriptive excess of the prespecified safety events. Because treatment allocation was not randomized and outcome assessment was open-label, these findings should be interpreted as adjusted associations rather than definitive causal effects and should be evaluated in adequately powered randomized or pragmatic trials.

Abstract: PubMed · Datensatz