Department of Pulmonary and Critical Care Medicine, China Centre of Respiratory Medicine, National Clinical Research Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Jinyintan Hospital, Wuhan, China.
Clin Microbiol Infect. 2021 Jan;27(1):112-117. doi: 10.1016/j.cmi.2020.09.045. Epub 2020 Sep 29.
Use of corticosteroids is common in the treatment of coronavirus disease 2019, but clinical effectiveness is controversial. We aimed to investigate the association of corticosteroids therapy with clinical outcomes of hospitalized COVID-19 patients.
In this single-centre, retrospective cohort study, adult patients with confirmed coronavirus disease 2019 and dead or discharged between 29 December 2019 and 15 February 2020 were studied; 1:1 propensity score matchings were performed between patients with or without corticosteroid treatment. A multivariable COX proportional hazards model was used to estimate the association between corticosteroid treatment and in-hospital mortality by taking corticosteroids as a time-varying covariate.
Among 646 patients, the in-hospital death rate was higher in 158 patients with corticosteroid administration (72/158, 45.6% vs. 56/488, 11.5%, p < 0.0001). After propensity score matching analysis, no significant differences were observed in in-hospital death between patients with and without corticosteroid treatment (47/124, 37.9% vs. 47/124, 37.9%, p 1.000). When patients received corticosteroids before they required nasal high-flow oxygen therapy or mechanical ventilation, the in-hospital death rate was lower than that in patients who were not administered corticosteroids (17/86, 19.8% vs. 26/86, 30.2%, log rank p 0.0102), whereas the time from admission to clinical improvement was longer (13 (IQR 10-17) days vs. 10 (IQR 8-13) days; p < 0.001). Using the Cox proportional hazards regression model accounting for time varying exposures in matched pairs, corticosteroid therapy was not associated with mortality difference (HR 0.98, 95% CI 0.93-1.03, p 0.4694).
Corticosteroids use in COVID-19 patients may not be associated with in-hospital mortality.
在治疗 2019 年冠状病毒病（COVID-19）中，皮质类固醇的使用很常见，但临床疗效存在争议。本研究旨在调查皮质类固醇治疗与住院 COVID-19 患者临床结局的关系。
在这项单中心回顾性队列研究中，研究了 2019 年 12 月 29 日至 2020 年 2 月 15 日期间确诊的 COVID-19 且死亡或出院的成年患者；对接受皮质类固醇治疗或未接受皮质类固醇治疗的患者进行了 1:1 倾向评分匹配。采用多变量 COX 比例风险模型，将皮质类固醇治疗作为时变协变量，估计皮质类固醇治疗与住院死亡率之间的关系。
在 646 例患者中，158 例皮质类固醇治疗患者的住院死亡率更高（72/158，45.6% vs. 56/488，11.5%，p<0.0001）。在倾向评分匹配分析后，皮质类固醇治疗与未治疗患者的住院死亡率无显著差异（47/124，37.9% vs. 47/124，37.9%，p=1.000）。当患者在需要接受高流量鼻氧疗或机械通气之前接受皮质类固醇治疗时，其住院死亡率低于未接受皮质类固醇治疗的患者（17/86，19.8% vs. 26/86，30.2%，log-rank p=0.0102），但临床改善时间更长（13（IQR 10-17）天 vs. 10（IQR 8-13）天；p<0.001）。在匹配对中考虑时变暴露的 Cox 比例风险回归模型中，皮质类固醇治疗与死亡率差异无关（HR 0.98，95%CI 0.93-1.03，p=0.4694）。
COVID-19 患者使用皮质类固醇可能与住院死亡率无关。
