Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
Expert Rev Respir Med. 2021 Apr;15(4):543-552. doi: 10.1080/17476348.2021.1856659. Epub 2021 Feb 1.
To explore the efficacy of corticosteroid treatment in patients with severe COVID-19 pneumonia and the association between corticosteroid use and patient mortality.
A retrospective investigation was made on the medical records of the patients with severe and critical patients with COVID-19 pneumonia from January to February 2020. First, the patients who received corticosteroid treatment were compared with patients without given corticosteroid treatment. Then, a propensity score matching method was used to control confounding factors. Cox survival regression analysis was used to evaluate the effect of corticosteroid therapy on the mortality of severe and critical patients with COVID-19.
A total of 371 severe and critical patients were included in our analyses. Two hundred and enine patients were treated with corticosteroid therapy. Most of them were treated with methylprednisolone (197[94.3%]). The median corticosteroid therapy was applied 3 (IQR 2-6) days after admission, 13 (IQR 10-17) days after symptoms appeared. Temperature on admission (OR = 1.255, [95%CI 1.021-1.547], p = 0.032), ventilation (OR = 1.926, [95%CI 1.148-3.269], p = 0.014) and ICU admission (OR = 3.713, [95%CI 1.776-8.277], p < 0.001) were significantly associated with corticosteroids use. After PS matching, the cox regression survival analysis showed that corticosteroid use was significantly associated with a lower mortality rate (HR = 0.592, [95%CI 0.406-0.862], p = 0.006).
Corticosteroid therapy use in severe and critical patients with COVID-19 pneumonia leads to lower mortality but may cause other side effects. Corticosteroid therapy should be used carefully.
探讨糖皮质激素治疗重症 COVID-19 肺炎患者的疗效及糖皮质激素使用与患者死亡率的关系。
对 2020 年 1 月至 2 月期间收治的重症和危重症 COVID-19 肺炎患者的病历进行回顾性调查。首先，比较了接受糖皮质激素治疗的患者与未接受糖皮质激素治疗的患者。然后，采用倾向评分匹配法控制混杂因素。采用 Cox 生存回归分析评估糖皮质激素治疗对重症和危重症 COVID-19 患者死亡率的影响。
共纳入 371 例重症和危重症患者。209 例患者接受糖皮质激素治疗。其中大部分患者接受甲基泼尼松龙治疗（197[94.3%]）。糖皮质激素治疗中位时间为入院后 3（IQR 2-6）天，症状出现后 13（IQR 10-17）天。入院时体温（OR=1.255，[95%CI 1.021-1.547]，p=0.032）、通气（OR=1.926，[95%CI 1.148-3.269]，p=0.014）和 ICU 入院（OR=3.713，[95%CI 1.776-8.277]，p<0.001）与糖皮质激素使用显著相关。PS 匹配后，Cox 回归生存分析显示，糖皮质激素使用与死亡率降低显著相关（HR=0.592，[95%CI 0.406-0.862]，p=0.006）。
糖皮质激素治疗重症和危重症 COVID-19 肺炎患者可降低死亡率，但可能导致其他副作用。糖皮质激素治疗应谨慎使用。
