COVID-19 患者全身糖皮质激素治疗对死亡率或机械通气的影响。
Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19.
机构信息
Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
Division of Rheumatology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
出版信息
J Hosp Med. 2020 Aug;15(8):489-493. doi: 10.12788/jhm.3497.
The efficacy of glucocorticoids in COVID-19 is unclear. This study was designed to determine whether systemic glucocorticoid treatment in COVID-19 patients is associated with reduced mortality or mechanical ventilation. This observational study included 1,806 hospitalized COVID-19 patients; 140 were treated with glucocorticoids within 48 hours of admission. Early use of glucocorticoids was not associated with mortality or mechanical ventilation. However, glucocorticoid treatment of patients with initial C-reactive protein (CRP) ≥20 mg/dL was associated with significantly reduced risk of mortality or mechanical ventilation (odds ratio, 0.23; 95% CI, 0.08-0.70), while glucocorticoid treatment of patients with CRP <10 mg/dL was associated with significantly increased risk of mortality or mechanical ventilation (OR, 2.64; 95% CI, 1.39-5.03). Whether glucocorticoid treatment is associated with changes in mortality or mechanical ventilation in patients with high or low CRP needs study in prospective, randomized clinical trials.
糖皮质激素治疗 COVID-19 的疗效尚不明确。本研究旨在确定 COVID-19 患者全身糖皮质激素治疗是否与死亡率或机械通气降低相关。本观察性研究纳入了 1806 例住院 COVID-19 患者；其中 140 例在入院后 48 小时内接受了糖皮质激素治疗。早期使用糖皮质激素与死亡率或机械通气无关。然而，对于初始 C 反应蛋白（CRP）≥20mg/dL 的患者，糖皮质激素治疗与死亡率或机械通气显著降低的风险相关（比值比，0.23；95%CI，0.08-0.70），而 CRP＜10mg/dL 的患者糖皮质激素治疗与死亡率或机械通气显著增加的风险相关（比值比，2.64；95%CI，1.39-5.03）。在前瞻性、随机临床试验中，需要研究 CRP 水平高或低的患者中糖皮质激素治疗是否与死亡率或机械通气变化相关。
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