Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.
Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study.
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DOI：
10.1016/j.cmi.2020.09.014
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
PREDICO Study Group
中科院分区：
文献类型：
--
作者：
Bartoletti M;Marconi L;Scudeller L;Pancaldi L;Tedeschi S;Giannella M;Rinaldi M;Bussini L;Valentini I;Ferravante AF;Potalivo A;Marchionni E;Fornaro G;Pascale R;Pasquini Z;Puoti M;Merli M;Barchiesi F;Volpato F;Rubin A;Saracino A;Tonetti T;Gaibani P;Ranieri VM;Viale P;Cristini F;PREDICO Study Group
评价糖皮质激素治疗2019年冠状病毒病患者的疗效(新冠肺炎)。从2020年2月22日至6月30日进行了一项多中心观察性研究。我们纳入了连续的患有严重新冠肺炎的成年患者，定义为呼吸频率≥30次/分钟，环境空气中氧饱和度≤93%或动脉血氧分压至吸入氧≤300毫米汞柱。我们排除了正在接受其他免疫调节药物治疗、接受小剂量皮质类固醇治疗以及入院72小时后接受皮质类固醇治疗的患者。主要终点是入院后30天的死亡率。主要暴露变量是皮质类固醇治疗，剂量为≥0.5mgKg，相当于泼尼松。在Logistic回归模型中，它被作为二项协变量引入，用于主要终点和使用倾向评分进行治疗加权的反向概率。在1,717名接受评估的新冠肺炎患者中，有513人纳入研究，其中170人(33%)接受了皮质类固醇治疗。在住院期间，166名患者(34%)符合主要结果标准(皮质类固醇组60/170，35%；非皮质类固醇组106/343，31%)。在多变量分析中，皮质类固醇治疗与较低的30天死亡率无关(调整后的优势比，0.59；95%可信区间，0.20-1.74；p 0.33)。在逆转治疗加权概率后，皮质类固醇与较低的30天死亡率无关(平均治疗效果，0.0 5；95%CI，−0.0 2至0.0 9；p 0.12)。然而，亚组分析显示，在入院时PO2/FiO2和200毫米汞柱的患者(135名患者，52名(38%)接受皮质类固醇治疗)中，皮质类固醇治疗与较低的30天死亡率相关(23/52，44%对45/83，54%；调整后的优势比，0.2；95%的可信区间，0.04-0.9；p 0.036)。皮质类固醇治疗对死亡率的影响可能仅限于新冠肺炎的危重患者。
To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19). A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score. Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20–1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, −0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04–0.90; p 0.036). The effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.
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影响因子：
25.4
作者：
Guaraldi, Giovanni;Meschiari, Marianna;Mussini, Cristina
通讯作者：
Mussini, Cristina
DOI：
10.1016/j.cmi.2020.07.016
发表时间：
2020-12
期刊：
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
影响因子：
--
作者：
Langford BJ;So M;Raybardhan S;Leung V;Westwood D;MacFadden DR;Soucy JR;Daneman N
通讯作者：
Daneman N
影响因子：
168.9
作者：
Huang, Chaolin;Wang, Yeming;Cao, Bin
通讯作者：
Cao, Bin
影响因子：
2.6
作者：
Rinaldi, Matteo;Bartoletti, Michele;Giannella, Maddalena
通讯作者：
Giannella, Maddalena
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
,