Department of Internal Medicine, Metropolitan Hospital, New York Medical College, New York, NY, United States of America.
Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, United States of America.
PLoS One. 2020 Sep 9;15(9):e0238827. doi: 10.1371/journal.pone.0238827. eCollection 2020.
The role of systemic corticosteroid as a therapeutic agent for patients with COVID-19 pneumonia is controversial.
The purpose of this study was to evaluate the effect of corticosteroids in non-intensive care unit (ICU) patients with COVID-19 pneumonia complicated by acute hypoxemic respiratory failure (AHRF).
This was a single-center retrospective cohort study, from 16th March, 2020 to 30th April, 2020; final follow-up on 10th May, 2020. 265 patients consecutively admitted to the non-ICU wards with laboratory-confirmed COVID-19 pneumonia were screened for inclusion. 205 patients who developed AHRF (SpO2/FiO2 ≤ 440 or PaO2/FiO2 ≤ 300) were only included in the final study. Direct admission to the Intensive care unit (ICU), patients developing composite primary outcome within 24 hours of admission, and patients who never became hypoxic during their stay in the hospital were excluded. Patients were divided into two cohorts based on corticosteroid. The primary outcome was a composite of ICU transfer, intubation, or in-hospital mortality. Secondary outcomes were ICU transfer, intubation, in-hospital mortality, discharge, length of stay, and daily trend of SpO2/FiO2 (SF) ratio from the index date. Cox-proportional hazard regression was implemented to analyze the time to event outcomes.
Among 205 patients, 60 (29.27%) were treated with corticosteroid. The mean age was ~57 years, and ~75% were men. Thirteen patients (22.41%) developed a primary composite outcome in the corticosteroid cohort vs. 54 (37.5%) patients in the non-corticosteroid cohort (P = 0.039). The adjusted hazard ratio (HR) for the development of the composite primary outcome was 0.15 (95% CI, 0.07-0.33; P <0.001). The adjusted hazard ratio for ICU transfer was 0.16 (95% CI, 0.07 to 0.34; P < 0.001), intubation was 0.31 (95% CI, 0.14 to 0.70; P- 0.005), death was 0.53 (95% CI, 0.22 to 1.31; P- 0.172), composite of death or intubation was 0.31 (95% CI, 0.15 to 0.66; P- 0.002) and discharge was 3.65 (95% CI, 2.20 to 6.06; P<0.001). The corticosteroid cohort had increasing SpO2/FiO2 over time compared to the non-corticosteroid cohort who experience decreasing SpO2/FiO2 over time.
Among non-ICU patients hospitalized with COVID-19 pneumonia complicated by AHRF, treatment with corticosteroid was associated with a significantly lower risk of the primary composite outcome of ICU transfer, intubation, or in-hospital death, composite of intubation or death and individual components of the primary outcome.
全身性皮质类固醇作为 COVID-19 肺炎患者的治疗药物的作用存在争议。
本研究旨在评估皮质类固醇在伴有急性低氧性呼吸衰竭（AHRF）的 COVID-19 肺炎非重症监护病房（ICU）患者中的作用。
这是一项单中心回顾性队列研究，时间为 2020 年 3 月 16 日至 4 月 30 日；最终随访时间为 2020 年 5 月 10 日。连续筛选了 265 例经实验室确诊的 COVID-19 肺炎入住非 ICU 病房的患者。仅纳入 205 例发生 AHRF（SpO2/FiO2≤440 或 PaO2/FiO2≤300）的患者进行最终研究。直接入住 ICU、入院后 24 小时内发生复合主要结局以及在住院期间从未出现低氧血症的患者被排除在外。根据皮质类固醇将患者分为两组。主要结局是 ICU 转科、插管或院内死亡的复合结局。次要结局是 ICU 转科、插管、院内死亡、出院、住院时间以及从索引日期开始的每日 SpO2/FiO2（SF）比值趋势。实施 Cox 比例风险回归分析时间事件结局。
在 205 例患者中，60 例（29.27%）接受了皮质类固醇治疗。平均年龄约为 57 岁，约 75%为男性。皮质类固醇组中有 13 例（22.41%）发生主要复合结局，而非皮质类固醇组中有 54 例（37.5%）（P=0.039）。发生复合主要结局的调整后风险比（HR）为 0.15（95%CI，0.07-0.33；P<0.001）。ICU 转科的调整后 HR 为 0.16（95%CI，0.07 至 0.34；P<0.001），插管的 HR 为 0.31（95%CI，0.14 至 0.70；P=0.005），死亡的 HR 为 0.53（95%CI，0.22 至 1.31；P=0.172），死亡或插管的复合 HR 为 0.31（95%CI，0.15 至 0.66；P=0.002），出院的 HR 为 3.65（95%CI，2.20 至 6.06；P<0.001）。与非皮质类固醇组相比，皮质类固醇组的 SpO2/FiO2 比值随时间逐渐升高，而非皮质类固醇组的 SpO2/FiO2 比值随时间逐渐下降。
在伴有急性低氧性呼吸衰竭的 COVID-19 肺炎非 ICU 住院患者中，皮质类固醇治疗与 ICU 转科、插管或院内死亡的主要复合结局以及插管或死亡的复合结局和主要结局的个别组成部分的风险显著降低相关。
