Institute of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria di Padova, Padova, Italy.
Institute of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria di Padova, Padova, Italy; University of Padova, Padova, Italy.
J Cardiothorac Vasc Anesth. 2021 Feb;35(2):578-584. doi: 10.1053/j.jvca.2020.11.057. Epub 2020 Nov 28.
Efficacy and safety of corticosteroids in patients with 2019-nCoV (novel coronavirus 2019) infection still are debated. Because large randomized clinical trials (RCTs) and a well-conducted meta-analysis on the use of corticosteroids, focused on patients with coronavirus disease (COVID-19) in intensive care units, recently were published, a meta-analysis of RCTs on corticosteroids therapy in patients with different disease severity was performed to evaluate the effect on survival.
A meta-analyses of RCTs was performed.
Patients admitted to hospital.
Patients with coronavirus disease.
Administration of corticosteroids.
A search was performed for RCTs of adult patients with acute hypoxemic failure related to 2019-nCoV infection who received corticosteroids versus any comparator. The primary endpoint was mortality rate. Five RCTs involving 7,692 patients were included. Overall mortality of patients treated with corticosteroids was slightly but significantly lower than mortality of controls (26% v 28%, relative risk {RR} = 0.89 [95% confidence interval {CI} 0.82-0.96], p = 0.003). The same beneficial effect was found in the subgroup of patients requiring mechanical ventilation (RR = 0.85 [95% CI 0.72-1.00], p = 0.05 number needed to treat {NNT} = 19). Remarkably, corticosteroids increased mortality in the subgroup of patients not requiring oxygen (17% v 13%, RR = 1.23 [95% CI 1.00-1.62], p = 0.05 number needed to harm {NNH} = 29). Tests for comparison between mechanically ventilated subgroups and those not requiring oxygen confirmed that treatment with corticosteroids had a statistically significant different effect on survival. Patients treated with corticosteroids had a significantly lower risk of need for mechanical ventilation.
Corticosteroids may be considered in severe critically ill patients with COVID-19 but must be discouraged in patients not requiring oxygen therapy. Urgently, further trials are warranted before implementing this treatment worldwide.
关于皮质类固醇治疗 2019-nCoV（新型冠状病毒 2019）感染患者的疗效和安全性仍存在争议。由于最近发表了大型随机临床试验（RCT）和一项精心设计的关于皮质类固醇治疗重症监护病房 COVID-19 患者的荟萃分析，因此对皮质类固醇治疗不同疾病严重程度患者的 RCT 进行了荟萃分析，以评估对生存率的影响。
进行了 RCT 的荟萃分析。
住院患者。
冠状病毒病患者。
皮质类固醇的给药。
对成人急性低氧性衰竭与 2019-nCoV 感染相关并接受皮质类固醇治疗与任何对照的 RCT 进行了检索。主要终点是死亡率。共纳入 5 项 RCT，涉及 7692 例患者。接受皮质类固醇治疗的患者死亡率略低于对照组（26%对 28%，相对风险 {RR} = 0.89 [95%置信区间 {CI} 0.82-0.96]，p = 0.003）。在需要机械通气的患者亚组中也发现了相同的有益效果（RR = 0.85 [95% CI 0.72-1.00]，p = 0.05 需要治疗的人数 {NNT} = 19）。值得注意的是，皮质类固醇增加了不需要吸氧患者的死亡率（17%对 13%，RR = 1.23 [95% CI 1.00-1.62]，p = 0.05 需要伤害的人数 {NNH} = 29）。对机械通气亚组和不需要吸氧亚组之间的比较检验证实，皮质类固醇治疗对生存率的影响具有统计学意义上的差异。接受皮质类固醇治疗的患者需要机械通气的风险显著降低。
皮质类固醇可考虑用于 COVID-19 重症患者，但必须避免用于不需要氧疗的患者。急需在全球范围内实施这种治疗之前，进行进一步的试验。
