Viral clearance after early corticosteroid treatment in patients with moderate or severe covid-19.
Viral clearance after early corticosteroid treatment in patients with moderate or severe covid-19.
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DOI：
10.1038/s41598-020-78039-1
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发表时间：
2020-12-04
影响因子：
4.6
通讯作者：
COVID-BioB study group
中科院分区：
文献类型：
--
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
本研究的目的是评估早期应用糖皮质激素对新冠肺炎患者SARS-CoV-2清除的影响。对意大利米兰圣拉斐尔医院收治的中/重度新冠肺炎患者进行了回顾性分析，这些患者至少可以获得两份鼻咽拭子。主要结果是鼻咽拭子阴性的时间。采用多变量COX模型分析鼻咽拭子阴性的相关因素。在纳入的280名患者中，59名患者(21.1%)接受了类固醇治疗。在使用类固醇和不使用类固醇之间观察到的差异包括基线PaO2/FiO2 ≤ 为200毫米汞柱(类固醇使用者和非类固醇使用者分别为45.8%和34.4%；p = 0.023)或 ≤ 100毫米汞柱(16.9%对12.7%；p = 0.027)的患者的比例，以及住院时间(20天对14天；p <； 0.001)。鼻咽拭子转阴的时间在类固醇使用者和非类固醇使用者中相似(p = 0.985)。根据多因素分析，SARS-CoV-2清除与年龄 ≤ 70岁、入院时症状持续时间较短、基线PaO2/FiO2 >； 为200毫米汞柱、入院时淋巴细胞计数 >； 1.0 × 109/L有关。我们的研究表明，中/重度新冠肺炎患者SARS-CoV-2清除延迟与年龄和更严重的疾病有关，但与早期使用皮质类固醇无关。
The aim of this study was to evaluate the impact of early treatment with corticosteroids on SARS-CoV-2 clearance in hospitalized COVID-19 patients. Retrospective analysis on patients admitted to the San Raffaele Hospital (Milan, Italy) with moderate/severe COVID-19 and availability of at least two nasopharyngeal swabs. The primary outcome was the time to nasopharyngeal swab negativization. A multivariable Cox model was fitted to determine factors associated with nasopharyngeal swab negativization. Of 280 patients included, 59 (21.1%) patients were treated with steroids. Differences observed between steroid users and non-users included the proportion of patients with a baseline PaO2/FiO2 ≤ 200 mmHg (45.8% vs 34.4% in steroids and non-steroids users, respectively; p = 0.023) or ≤ 100 mmHg (16.9% vs 12.7%; p = 0.027), and length of hospitalization (20 vs 14 days; p < 0.001). Time to negativization of nasopharyngeal swabs was similar in steroid and non-steroid users (p = 0.985). According to multivariate analysis, SARS-CoV-2 clearance was associated with age ≤ 70 years, a shorter duration of symptoms at admission, a baseline PaO2/FiO2 > 200 mmHg, and a lymphocyte count at admission > 1.0 × 109/L. SARS-CoV-2 clearance was not associated with corticosteroid use. Our study shows that delayed SARS-CoV-2 clearance in moderate/severe COVID-19 is associated with older age and a more severe disease, but not with an early use of corticosteroids.
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