Low-to-moderate dose corticosteroids treatment in hospitalized adults with COVID-19.
Low-to-moderate dose corticosteroids treatment in hospitalized adults with COVID-19.
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DOI：
10.1016/j.cmi.2020.09.045
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Cao B
中科院分区：
文献类型：
--
作者：
Liu Z;Li X;Fan G;Zhou F;Wang Y;Huang L;Yu J;Yang L;Shang L;Xie K;Xu J;Huang Z;Gu X;Li H;Zhang Y;Wang Y;Huang Z;Cao B
使用皮质类固醇治疗2019冠状病毒病很常见，但临床效果存在争议。我们的目的是研究糖皮质激素治疗与住院COVID-19患者临床结局的关系。在这项单中心回顾性队列研究中，研究了2019年12月29日至2020年2月15日期间死亡或出院的2019年冠状病毒病确诊成年患者；在接受或未接受皮质类固醇治疗的患者之间进行1:1的倾向评分匹配。采用多变量COX比例风险模型，以皮质类固醇作为时变协变量，估计皮质类固醇治疗与住院死亡率之间的关系。在646例患者中，使用皮质类固醇治疗的患者中有158例住院死亡率较高（72/158,45.6%比56/488,11.5%,p < 0.0001）。经倾向评分匹配分析，接受和未接受皮质类固醇治疗的患者住院死亡率无显著差异（47/124,37.9% vs. 47/124, 37.9%, p 1.000）。患者在接受鼻高流量氧疗或机械通气前接受糖皮质激素治疗，住院死亡率低于未接受糖皮质激素治疗的患者（17/ 86,19.8% vs. 26/ 86,30.2%, log rank p 0.0102），而入院至临床改善所需时间更长(13 （IQR 10 - 17）天vs. 10 （IQR 8-13）天；p < 0.001)。使用Cox比例风险回归模型考虑配对组中随时间变化的暴露，皮质类固醇治疗与死亡率差异无关（HR 0.98, 95% CI 0.93-1.03, p 0.4694）。COVID-19患者使用皮质类固醇可能与院内死亡率无关。
Use of corticosteroids is common in the treatment of coronavirus disease 2019, but clinical effectiveness is controversial. We aimed to investigate the association of corticosteroids therapy with clinical outcomes of hospitalized COVID-19 patients. In this single-centre, retrospective cohort study, adult patients with confirmed coronavirus disease 2019 and dead or discharged between 29 December 2019 and 15 February 2020 were studied; 1:1 propensity score matchings were performed between patients with or without corticosteroid treatment. A multivariable COX proportional hazards model was used to estimate the association between corticosteroid treatment and in-hospital mortality by taking corticosteroids as a time-varying covariate. Among 646 patients, the in-hospital death rate was higher in 158 patients with corticosteroid administration (72/158, 45.6% vs. 56/488, 11.5%, p < 0.0001). After propensity score matching analysis, no significant differences were observed in in-hospital death between patients with and without corticosteroid treatment (47/124, 37.9% vs. 47/124, 37.9%, p 1.000). When patients received corticosteroids before they required nasal high-flow oxygen therapy or mechanical ventilation, the in-hospital death rate was lower than that in patients who were not administered corticosteroids (17/86, 19.8% vs. 26/86, 30.2%, log rank p 0.0102), whereas the time from admission to clinical improvement was longer (13 (IQR 10–17) days vs. 10 (IQR 8–13) days; p < 0.001). Using the Cox proportional hazards regression model accounting for time varying exposures in matched pairs, corticosteroid therapy was not associated with mortality difference (HR 0.98, 95% CI 0.93–1.03, p 0.4694). Corticosteroids use in COVID-19 patients may not be associated with in-hospital mortality.
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发表时间：
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影响因子：
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发表时间：
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