Possibility of deterioration of respiratory status when steroids precede antiviral drugs in patients with COVID-19 pneumonia: A retrospective study.
Possibility of deterioration of respiratory status when steroids precede antiviral drugs in patients with COVID-19 pneumonia: A retrospective study.
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DOI：
10.1371/journal.pone.0256977
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Suzuki T
中科院分区：
文献类型：
--
作者：
Shionoya Y;Taniguchi T;Kasai H;Sakuma N;Imai S;Shikano K;Takayanagi S;Yahaba M;Nakada TA;Igari H;Sakao S;Suzuki T
冠状病毒病(新冠肺炎)是由严重急性呼吸综合征冠状病毒2型引起的。虽然大多数新冠肺炎患者发展为无症状或轻微疾病，但也有一些患者发展为严重疾病。新冠肺炎的各种治疗药物，包括抗病毒药物、类固醇和消炎药的有效性已经得到证实。使用类固醇治疗早期疾病的效果尚不清楚。因此，本研究旨在评估新冠肺炎肺炎患者先行应用类固醇抗病毒药物的有效性和恶化风险。这项回顾性、单中心、观察性研究包括2020年3月至2021年3月期间连续的新冠肺炎患者。患者被分成类固醇优先组和抗病毒药物优先组。比较两组患者的病死率、住院天数、重症监护病房(ICU)入院、插管及体外膜肺(ECMO)诱导的发生率和持续时间。在研究期间，共有258名患者入院。在排除了仅接受对症治疗、服用免疫抑制药物或仅服用抗病毒药物的患者后，68名患者被纳入分析，其中16名患者在类固醇第一组，52名患者在抗病毒药物第一组。激素组的插管率、ICU住院率和体外反搏诱导率显著高于抗病毒药物组(分别为81.3%和33.3%，p=0.001；75.0%和29.4%，p=0.001和31.3%和7.8%，p=0.017)。此外，在开始服用抗病毒药物后10天内接受类固醇治疗的患者的ICU入院率、插管率和ECMO诱导率明显较低。(81.3%vs.42.9%p=0.011，75.0%vs.37.1%p=0.012，31.3%vs.8.6%p=0.039)。症状出现后不久，在服用抗病毒药物之前使用类固醇会加重疾病的严重程度。当考虑在症状出现后不久给予类固醇治疗时，首先开始使用抗病毒药物可能更安全。
Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Although most patients with COVID-19 develop asymptomatic or mild disease, some patients develop severe disease. The effectiveness of various therapeutic agents, including antiviral drugs, steroids, and anti-inflammatories for COVID-19, have been being confirmed. The effect of administering steroids in early disease is unclear. This study therefore aimed to evaluate the effectiveness and risk of exacerbation of steroids administered preceding antiviral drugs in patients with COVID-19 pneumonia. This retrospective, single-center, observational study included consecutive patients with COVID-19 between March 2020 and March 2021. Patients were divided into a steroids-first group and antiviral-drugs-first group. Mortality, duration of hospitalization, incidence rate and duration of intensive care unit (ICU) admission, intubation, and extracorporeal membrane oxygenation (ECMO) induction of the two groups were compared. A total of 258 patients were admitted during the study period. After excluding patients who received symptomatic treatment only, who were taking immunosuppressive drugs, or who were administered antiviral drugs only, 68 patients were included in the analysis, 16 in the steroids-first group and 52 in the antiviral-drugs-first group. The rate of intubation, ICU admission and ECMO induction were significantly higher in the steroids-first group than in the antiviral-drugs-first group (81.3% vs. 33.3, p<0.001, 75.0% vs. 29.4%, p = 0.001, and 31.3% vs. 7.8%, p = 0.017, respectively). Furthermore, patients who received steroids within ten days after starting antiviral drugs had significantly lower rates of ICU admission, intubation, and ECMO induction. (81.3% vs. 42.9% p = 0.011, 75.0% vs. 37.1% p = 0.012, and 31.3% vs. 8.6% p = 0.039, respectively). Administering steroids prior to antiviral drugs soon after symptom onset can aggravate disease severity. When administration of steroids is considered soon after symptom onset, it may be safer to initiate antiviral drugs first.
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影响因子：
4.6
作者：
Spagnuolo V;Guffanti M;Galli L;Poli A;Querini PR;Ripa M;Clementi M;Scarpellini P;Lazzarin A;Tresoldi M;Dagna L;Zangrillo A;Ciceri F;Castagna A;COVID-BioB study group
通讯作者：
COVID-BioB study group
影响因子：
15.9
作者：
Wang, Yanqun;Zhang, Lu;Zhao, Jincun
通讯作者：
Zhao, Jincun
DOI：
10.1016/s2352-3026(21)00105-8
发表时间：
2021-07
期刊：
The Lancet. Haematology
影响因子：
--
作者：
Leentjens J;van Haaps TF;Wessels PF;Schutgens REG;Middeldorp S
通讯作者：
Middeldorp S
影响因子：
2.6
作者：
Frediansyah A;Tiwari R;Sharun K;Dhama K;Harapan H
通讯作者：
Harapan H
影响因子：
2.8
作者：
Pasin L;Navalesi P;Zangrillo A;Kuzovlev A;Likhvantsev V;Hajjar LA;Fresilli S;Lacerda MVG;Landoni G
通讯作者：
Landoni G