Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France.
Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France.
Int J Antimicrob Agents. 2020 Aug;56(2):106077. doi: 10.1016/j.ijantimicag.2020.106077. Epub 2020 Jul 4.
Anti-inflammatory drugs such as corticosteroids may beneficially modulate the host inflammatory response to coronavirus disease 2019 (COVID-19) pneumonia. The aim of this study was to evaluate the impact of addition of corticosteroids to the hospital protocol for treatment of suspected or confirmed COVID-19 pneumonia on rates of death or intensive care unit (ICU) admission. A before-after study was performed to evaluate the effect of addition of corticosteroids to our institution's COVID-19 treatment protocol on hospital mortality. A total of 257 patients with a COVID-19 diagnosis were included in this study between 3 March 2020 and 14 April 2020. As corticosteroids were widely used after 27 March 2020, two periods were considered for the purposes of this study: the 'before' period from 3-20 March 2020 (n = 85); and the 'after' period from 26 March-14 April 2020 (n = 172). The 'after' period was associated with a lower risk of death [adjusted hazard ratio (aHR) = 0.47, 95% confidence interval (CI) 0.23-0.97; P = 0.04] and a lower risk of ICU admission or of death before ICU admission (aHR = 0.37, 95% CI 0.21-0.64; P = 0.0005) by multivariate analysis adjusted for age, National Early Warning score and institutionalisation status. In conclusion, addition of corticosteroids to our institution's COVID-19 treatment protocol was associated with a significant reduction in hospital mortality in the 'after' period.
抗炎药物，如皮质类固醇，可能有益于调节宿主对 2019 年冠状病毒病（COVID-19）肺炎的炎症反应。本研究旨在评估在治疗疑似或确诊 COVID-19 肺炎的医院方案中添加皮质类固醇对死亡率或重症监护病房（ICU）入院率的影响。进行了一项前后研究，以评估在我们机构的 COVID-19 治疗方案中添加皮质类固醇对医院死亡率的影响。本研究共纳入了 2020 年 3 月 3 日至 2020 年 4 月 14 日期间确诊为 COVID-19 的 257 例患者。由于皮质类固醇在 2020 年 3 月 27 日之后广泛使用，因此本研究考虑了两个时期：“前”期为 2020 年 3 月 3 日至 20 日（n=85）；“后”期为 2020 年 3 月 26 日至 4 月 14 日（n=172）。多变量分析调整年龄、国家早期预警评分和机构化状态后，“后”期死亡率的风险降低[调整后的危险比（aHR）=0.47，95%置信区间（CI）0.23-0.97；P=0.04]，且 ICU 入院或 ICU 入院前死亡的风险降低（aHR=0.37，95%CI 0.21-0.64；P=0.0005）。总之，在我们机构的 COVID-19 治疗方案中添加皮质类固醇与“后”期医院死亡率的显著降低相关。
