Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19
Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19
复制标题
DOI：
10.1093/cid/ciaa601
复制
发表时间：
2020-10-15
影响因子：
11.8
通讯作者：
Ramesh, Mayur S.
中科院分区：
文献类型：
--
作者：
Fadel, Raef;Morrison, Austin R.;Ramesh, Mayur S.
背景目前尚无针对2019冠状病毒病（COVID-19）的经证实的抗病毒或免疫调节疗法。与促炎宿主反应相关的疾病进展促使我们研究早期皮质类固醇治疗在中重度COVID-19患者中的作用。我们于2020年3月12日至3月27日在密歇根州的一个多中心卫生系统中进行了一项前测、一项后测准实验。纳入了确诊为中度至重度COVID的成人患者。于2020年3月20日实施了一项方案，使用早期、短程、甲泼尼龙0.5至1 mg/kg/天，分2次静脉给药，持续3天。评估了标准护理（SOC）和早期皮质类固醇组的结局，主要复合终点为从病房到重症监护室（ICU）的护理升级、对机械通气的新要求和死亡率。所有患者至少随访14天。我们分析了213例合格受试者，SOC组和早期皮质类固醇组分别为81例（38%）和132例（62%）。早期皮质类固醇组的复合终点发生率显著较低（34.9% vs 54.3%，P = 0.005）。在复合终点的每个单独组分中观察到该治疗效应。早期皮质类固醇组的平均住院时间也显著缩短（5天vs 8天，P <0.001）。多变量回归分析显示，在控制其他因素的情况下，第14天复合终点的独立降低（校正比值比：0.41; 95%置信区间，0.22 - 0.77）。在中重度COVID-19患者中早期短期使用甲基强的松龙，减少了护理升级并改善了临床结局。
Background. There is no proven antiviral or immunomodulatory therapy for coronavirus disease 2019 (COVID-19). The disease progression associated with the proinflammatory host response prompted us to examine the role of early corticosteroid therapy in patients with moderate to severe COVID-19.Methods. We conducted a single pretest, single posttest quasi-experiment in a multicenter health system in Michigan from 12 March to 27 March 2020. Adult patients with confirmed moderate to severe COVID were included. A protocol was implemented on 20 March 2020 using early, short-course, methylprednisolone 0.5 to 1 mg/kg/day divided in 2 intravenous doses for 3 days. Outcomes of standard of care (SOC) and early corticosteroid groups were evaluated, with a primary composite endpoint of escalation of care from ward to intensive care unit (ICU), new requirement for mechanical ventilation, and mortality. All patients had at least 14 days of follow-up.Results. We analyzed 213 eligible subjects, 81 (38%) and 132 (62%) in SOC and early corticosteroid groups, respectively. The composite endpoint occurred at a significantly lower rate in the early corticosteroid group (34.9% vs 54.3%, P = .005). This treatment effect was observed within each individual component of the composite endpoint. Significant reduction in median hospital length of stay was also observed in the early corticosteroid group (5 vs 8 days, P < .001). Multivariate regression analysis demonstrated an independent reduction in the composite endpoint at 14-days controlling for other factors (adjusted odds ratio: 0.41; 95% confidence interval, .22 - .77).Conclusions. An early short course of methylprednisolone in patients with moderate to severe COVID-19 reduced escalation of care and improved clinical outcomes.