Clinical features of COVID-19 patients with rebound phenomenon after corticosteroid therapy
Clinical features of COVID-19 patients with rebound phenomenon after corticosteroid therapy
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DOI：
10.1136/bmjresp-2022-001332
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发表时间：
2022-09-05
影响因子：
4.1
通讯作者：
中科院分区：
文献类型：
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糖皮质激素治疗在COVID-19呼吸衰竭患者的治疗中起着关键作用。然而，类固醇停止后的反弹现象很少发生。在这里，我们调查了类固醇治疗后反跳患者的临床特征。总共招募了84名接受皮质类固醇治疗的COVID-19患者并进行了回顾性分析。反跳定义为停止皮质类固醇治疗后患者呼吸状态恶化，无继发性细菌感染。反跳组较非反跳组更易发生重度呼吸衰竭。虽然反跳组的类固醇治疗持续时间较长（8天vs 10天，p=0.0009），但两组之间的类固醇剂量和开始或终止类固醇治疗的时间无任何差异（分别为p=0.17和0.68）。反跳组治疗前血清可溶性白细胞介素2受体（sIL-2 R）水平及激素治疗结束时血清C反应蛋白（CRP）、乳酸脱氢酶（LDH）水平均显著高于对照组（分别为937与1336 U/mL; p=0.002、0.63与3.96 mg/dL; p=0.01和278与451 IU/mL; p=0.01）。反弹组中没有患者出现血栓，死亡原因是COVID-19恶化、呼吸机相关肺炎或败血症。使用反弹现象基线特征的预测模型包括年龄>68岁、所需辅助供氧>5 L/min、淋巴细胞计数<792 /µL和sIL-2 R>1146 U/mL四个变量。该模型的判别能力为0.906（0.755-0.968）。结果提示，严重呼吸衰竭患者停用糖皮质激素后发生反跳的危险性较高，血清sIL-2 R、LDH和CRP水平可作为判断反跳发生的指标。一个多变量模型被开发来预测反弹风险，它显示出可接受的区分能力。
Corticosteroid therapy plays a key role in the treatment of COVID-19 patients with respiratory failure. However, a rebound phenomenon after steroid cessation rarely occurs. Here, we investigated the clinical features of patients with rebound after steroid therapy. In total, 84 patients with COVID-19 treated with corticosteroids were enrolled and analysed retrospectively. A rebound was defined as when a patient’s respiratory status deteriorated after the cessation of corticosteroid therapy, without secondary bacterial infection. Subjects in the rebound group were more likely to having severe respiratory failure than those in the non-rebound group. While the duration of steroid therapy was longer in the rebound group (8 days vs 10 days, p=0.0009), the dosage of steroid and the timing of the start or termination of steroid therapy did not show any differences between the two groups (p=0.17 and 0.68, respectively). The values of soluble interleukin-2 receptor (sIL-2R) at the baseline and the values of C reactive protein (CRP) or lactate dehydrogenase (LDH) at the end of steroid therapy were significantly higher in the rebound group (937 vs 1336 U/mL; p=0.002, 0.63 vs 3.96 mg/dL; p=0.01 and 278 vs 451 IU/mL; p=0.01, respectively). No patient in the rebound group suffered from thromboses, and the causes of death were exacerbation of COVID-19, ventilator-associated pneumonia or sepsis. The prediction model using baseline features for the rebound phenomenon included four variables of age >68 years, required supplemental oxygen >5 L/min, lymphocyte counts <792 /µL and sIL-2R >1146 U/mL. The discrimination ability of this model was 0.906 (0.755–0.968). These findings suggest that severe respiratory failure has a higher risk for the rebound phenomenon after the cessation of corticosteroids, and the values of sIL-2R, LDH and CRP are useful to assess the probability of developing rebound. A multivariate model was developed to predict rebound risk, which showed acceptable discrimination ability.
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DOI：
10.1056/nejmoa2022926
发表时间：
2020-11-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
RECOVERY Collaborative Group;Horby P;Mafham M;Linsell L;Bell JL;Staplin N;Emberson JR;Wiselka M;Ustianowski A;Elmahi E;Prudon B;Whitehouse T;Felton T;Williams J;Faccenda J;Underwood J;Baillie JK;Chappell LC;Faust SN;Jaki T;Jeffery K;Lim WS;Montgomery A;Rowan K;Tarning J;Watson JA;White NJ;Juszczak E;Haynes R;Landray MJ
通讯作者：
Landray MJ
影响因子：
3.7
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
通讯作者：
Suzuki T
影响因子：
39
作者：
Wu, Chaomin;Chen, Xiaoyan;Song, Yuanlin
通讯作者：
Song, Yuanlin
影响因子：
158.5
作者：
Gupta, Anil;Gonzalez-Rojas, Yaneicy;Shapiro, Adrienne E.
通讯作者：
Shapiro, Adrienne E.
影响因子：
3.1
作者：
Imai R;Ro S;Tomishima Y;Nishimura N
通讯作者：
Nishimura N