title: Effects of glucocorticoids on the neutrophil count: a cohort study among hospitalized patients.
abstract: BACKGROUND
  Systemic glucocorticoids are often used in clinical practice for a large variety of indications. Clinical observations have shown that patients using glucocorticoids often have higher neutrophil counts. Debate remains whether this observed neutrophilia is associated with glucocorticoid use or that other factors, like disease and severity of disease, should be considered. The objective of this study was to investigate the effect of systemic glucocorticoids on the absolute neutrophil count in hospitalized patients.
  
  
  METHODS
  A cohort study was conducted using data from the Utrecht Patient Oriented Database which comprises clinical data of patients of the University Medical Center Utrecht. We identified all adult patients, hospitalized in 2005 with at least two blood samples for hematological testing during admission and compared in-hospital glucocorticoid use with non-use.
  
  
  RESULTS
  A total of 809 glucocorticoid users and 2658 non-users were included in the study with comparable neutrophil counts at admission (8.2.10(9)/l for glucocorticoid users and 8.0.10(9)/l for non-users). Overall analysis showed a slight association between glucocorticoid use and an increase in neutrophil count (RR 1.3; 95% CI 1.1-1.5). However, within diagnostic subgroups there was no increase in neutrophil count in glucocorticoid users. Furthermore, among all no dose response relationship, no effect of time between the two samples, and no effect of anti-inflammatory/sodium retaining potency was found.
  
  
  CONCLUSIONS
  Observed neutrophilia in users of systemic glucocorticoids is probably associated with underlying disease, rather than glucocorticoid use itself.
authors.affiliation: Faculty of Science, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB Utrecht, The Netherlands.
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Velthove
authors.forename: Hubert G M
authors.initials: HG
authors.lastname: Leufkens
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Souverein
authors.forename: René C
authors.initials: RC
authors.lastname: Schweizer
authors.forename: Madelon
authors.initials: M
authors.lastname: Bracke
authors.forename: Wouter W
authors.initials: WW
authors.lastname: van Solinge
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009504:Neutrophils / Q000187:drug effects* / Q000378:metabolism; D012720:Severity of Illness Index
chemical_list: D005938:Glucocorticoids