Corticosteroid Therapy Is Associated With Improved Outcome in Critically Ill Patients With COVID-19 With Hyperinflammatory Phenotype.
Corticosteroid Therapy Is Associated With Improved Outcome in Critically Ill Patients With COVID-19 With Hyperinflammatory Phenotype.
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DOI：
10.1016/j.chest.2020.11.050
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发表时间：
2021-05
期刊：
影响因子：
9.6
通讯作者：
Qiu H
中科院分区：
文献类型：
--
作者：
Chen H;Xie J;Su N;Wang J;Sun Q;Li S;Jin J;Zhou J;Mo M;Wei Y;Chao Y;Hu W;Du B;Qiu H
皮质类固醇治疗通常用于COVID-19患者，尽管其对预后的影响以及哪些患者可以从皮质类固醇治疗中受益尚不确定。COVID-19的临床表型与对皮质类固醇治疗的不同反应相关吗？纳入2020年1月至2月在同济医院治疗的COVID-19危重患者，主要暴露点为静脉注射皮质类固醇。主要终点为28天死亡率。边际结构模型用于考虑基线和时间相关的混杂因素。采用无监督机器学习方法来识别COVID-19的表型。共纳入428例患者；428例患者中有280例（65.4%）接受了皮质类固醇治疗。接受皮质类固醇治疗的患者28天死亡率显著高于未接受皮质类固醇治疗的患者（53.9% vs 19.6%; P < 0.0001）。在边缘结构建模后，皮质类固醇治疗与28天死亡率无显著相关性（风险比[HR]， 0.80; 95% CI, 0.54-1.18; P = 0.26）。我们的分析确定了COVID-19的两种表型，与低炎症表型相比，高炎症表型的特征是促炎细胞因子水平升高，顺序器官衰竭评估评分更高，并发症发生率更高。皮质类固醇治疗与高炎症表型患者28天死亡率降低相关（HR, 0.45; 95% CI, 0.25-0.80; P = 0.0062）。对于COVID-19危重患者，皮质类固醇治疗与28天死亡率无关，但皮质类固醇的使用在高炎症表型患者中显示出显着的生存益处。
Corticosteroid therapy is used commonly in patients with COVID-19, although its impact on outcomes and which patients could benefit from corticosteroid therapy are uncertain. Are clinical phenotypes of COVID-19 associated with differential response to corticosteroid therapy? Critically ill patients with COVID-19 from Tongji Hospital treated between January and February 2020 were included, and the main exposure of interest was the administration of IV corticosteroids. The primary outcome was 28-day mortality. Marginal structural modeling was used to account for baseline and time-dependent confounders. An unsupervised machine learning approach was carried out to identify phenotypes of COVID-19. A total of 428 patients were included; 280 of 428 patients (65.4%) received corticosteroid therapy. The 28-day mortality was significantly higher in patients who received corticosteroid therapy than in those who did not (53.9% vs 19.6%; P < .0001). After marginal structural modeling, corticosteroid therapy was not associated significantly with 28-day mortality (hazard ratio [HR], 0.80; 95% CI, 0.54-1.18; P = .26). Our analysis identified two phenotypes of COVID-19, and compared with the hypoinflammatory phenotype, the hyperinflammatory phenotype was characterized by elevated levels of proinflammatory cytokines, higher Sequential Organ Failure Assessment scores, and higher rates of complications. Corticosteroid therapy was associated with a reduced 28-day mortality (HR, 0.45; 95% CI, 0.25-0.80; P = .0062) in patients with the hyperinflammatory phenotype. For critically ill patients with COVID-19, corticosteroid therapy was not associated with 28-day mortality, but the use of corticosteroids showed significant survival benefits in patients with the hyperinflammatory phenotype.
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DOI：
10.1164/rccm.201603-0645oc
发表时间：
2017-02-01
影响因子：
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作者：
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影响因子：
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作者：
Chen RC;Tang XP;Tan SY;Liang BL;Wan ZY;Fang JQ;Zhong N
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DOI：
10.1186/s13054-016-1230-8
发表时间：
2016-03-30
期刊：
Critical care (London, England)
影响因子：
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作者：
Delaney JW;Pinto R;Long J;Lamontagne F;Adhikari NK;Kumar A;Marshall JC;Cook DJ;Jouvet P;Ferguson ND;Griesdale D;Burry LD;Burns KE;Hutchison J;Mehta S;Menon K;Fowler RA;Canadian Critical Care Trials Group H1N1 Collaborative
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Canadian Critical Care Trials Group H1N1 Collaborative