Department of Anesthesia, Intensive Care and Pain medicine, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
Department of Laboratory Medicine, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
Clin Pharmacol Ther. 2021 Jun;109(6):1660-1667. doi: 10.1002/cpt.2245. Epub 2021 Apr 19.
The most beneficial effect of corticosteroid therapy in COVID-19 patients has been shown in subjects receiving invasive mechanical ventilation (IMV), corresponding to a score of 6 on the World Health Organization (WHO) COVID-19 Ordinal Scale for Clinical Improvement (OSCI). The aim of this observational, single-center, prospective study was to assess the association between corticosteroids and hospital mortality in coronavirus disease 2019 (COVID-19) patients who did not receive IMV (OSCI 3-5). Included were 1,311 COVID-19 patients admitted to nonintensive care wards, and they were divided in two cohorts: (i) 480 patients who received corticosteroid therapy and (ii) 831 patients who did not. The median daily dose was of 8 mg of dexamethasone or equivalent, with a mean therapy duration of 5 (3-9) days. The indication to administer or withhold corticosteroids was given by the treating physician. In-hospital mortality was similar between the two cohorts after adjusting for possible confounders (adjusted odds ratio (ORadj) 1.04, 95% confidence interval (CI), 0.81-1.34, P = 0.74). There was also no difference in Intensive Care Unit (ICU) admission (ORadj 0.81, 95% CI, 0.56-1.17, P = 0.26). COVID-19 patients with noninvasive mechanical ventilation (NIMV) had a lower risk for ICU admission if they received steroid therapy (ORadj 0.58, 95% CI, 0.35-0.94, P = 0.03). In conclusion, corticosteroids were overall not associated with a difference in hospital mortality for patients with COVID-19 with OSCI 3-5. In the subgroup of patients with NIMV (OSCI 5), corticosteroids reduced ICU admission, whereas the effect on mortality requires further studies.
皮质类固醇治疗 COVID-19 患者的最有益效果已在接受有创机械通气 (IMV) 的患者中显示，这对应于世界卫生组织 (WHO) COVID-19 临床改善等级量表 (OSCI) 的 6 分。这项观察性、单中心、前瞻性研究的目的是评估在未接受 IMV（OSCI 3-5）的 COVID-19 患者中皮质类固醇与医院死亡率之间的关联。纳入了 1311 名入住非重症监护病房的 COVID-19 患者，并将他们分为两个队列：（i）接受皮质类固醇治疗的 480 名患者和（ii）未接受皮质类固醇治疗的 831 名患者。每日平均剂量为 8mg 地塞米松或等效剂量，平均治疗时间为 5（3-9）天。给予或不给予皮质类固醇的指示由主治医生决定。调整可能的混杂因素后，两个队列的住院死亡率相似（调整后的优势比 (ORadj) 1.04，95%置信区间 (CI) 0.81-1.34，P=0.74）。入住重症监护病房 (ICU) 的差异也无统计学意义（ORadj 0.81，95% CI，0.56-1.17，P=0.26）。如果 COVID-19 患者接受有创机械通气 (NIMV)，则接受类固醇治疗的 ICU 入院风险较低（ORadj 0.58，95% CI，0.35-0.94，P=0.03）。总之，皮质类固醇总体上与 OSCI 3-5 的 COVID-19 患者的住院死亡率无差异。在接受无创机械通气 (NIMV)（OSCI 5）的患者亚组中，皮质类固醇可降低 ICU 入院率，而对死亡率的影响需要进一步研究。
