Service de Pharmacologie Médicale, Centre Hospitalier Universitaire de Toulouse, Faculté de Médecine, 37 allées Jules Guesde, 31000, Toulouse, France.
Centre d'investigation clinique 1436, axe pharmacoépidémiologie, Centre Hospitalier Universitaire de Toulouse-Purpan, place du Dr Baylac, TSA40031, 31059, Toulouse, Cedex 9, France.
BMC Pharmacol Toxicol. 2021 Mar 11;22(1):14. doi: 10.1186/s40360-021-00480-3.
The impact of prior exposure to systemic corticosteroids on COVID-19 severity in patients hospitalized for a SARS-CoV-2 pneumonia is not known. The present study was designed to answer to this question.
The population study was the Covid-Clinic-Toul cohort which records data about all hospitalized patients with a positive reverse transcriptase polymerase chain reaction for a SARS-CoV-2 infection at Toulouse University hospital, France. Exposure to systemic corticosteroids was assessed at hospital admission. A propensity score (PS) according to corticosteroid exposure was calculated including comorbidities, clinical, radiological and biological variables that impact COVID-19 severity. The primary outcome was composite, including admission to intensive care unit, need of mechanical ventilation and death occurring during the 14 days after hospital admission. Logistic regression models adjusted for the PS (overlap weighting) provided odds ratios (ORs) and their 95% confidence intervals (95% CIs).
Overall, 253 patients were included in the study. Median age was 64 years, 140 patients (59.6%) were men and 218 (86.2%) had at least one comorbidity. Seventeen patients (6.7%) were exposed to corticosteroids before hospital admission. Chronic inflammatory disease (n = 8) was the most frequent indication. One hundred and twenty patients (47.4%) met the composite outcome. In the crude model, the OR of previous exposure to systemic corticosteroids was 1.64; 95% CI: 0.60-4.44. In the adjusted model, it was 1.09 (95% CI: 0.65-1.83).
Overall, this study provide some evidences for an absence of an increased risk of unfavorable outcome with previous exposure to corticosteroids in the general setting of patients hospitalized for COVID-19.
先前暴露于全身皮质类固醇对因 SARS-CoV-2 肺炎住院的 COVID-19 患者的严重程度的影响尚不清楚。本研究旨在回答这个问题。
该人群研究是 COVID-Clinic-Toul 队列，该队列记录了法国图卢兹大学医院所有因 SARS-CoV-2 感染而进行阳性逆转录酶聚合酶链反应的住院患者的数据。在入院时评估全身皮质类固醇的暴露情况。根据皮质类固醇暴露情况计算倾向评分（PS），包括影响 COVID-19 严重程度的合并症、临床、影像学和生物学变量。主要结局是包括入住重症监护病房、需要机械通气和入院后 14 天内死亡的复合结局。使用 PS（重叠加权）调整的逻辑回归模型提供了比值比（OR）及其 95%置信区间（95%CI）。
共有 253 名患者纳入研究。中位年龄为 64 岁，140 名患者（59.6%）为男性，218 名患者（86.2%）至少有 1 种合并症。17 名患者（6.7%）在入院前接受了皮质类固醇治疗。慢性炎症性疾病（n=8）是最常见的适应证。120 名患者（47.4%）出现复合结局。在未调整模型中，先前暴露于全身皮质类固醇的 OR 为 1.64；95%CI：0.60-4.44。在调整模型中，它为 1.09（95%CI：0.65-1.83）。
总体而言，这项研究提供了一些证据，表明在 COVID-19 住院患者的一般人群中，先前暴露于皮质类固醇不会增加不良结局的风险。
