Calzetta Luigino, Aiello Marina, Frizzelli Annalisa, Rogliani Paola, Chetta Alfredo
Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy.
Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy.
J Clin Med. 2021 Apr 10;10(8):1607. doi: 10.3390/jcm10081607.
A clinical interpretation of the Randomized Evaluation of COVID-19 Therapy (RECOVERY) study was performed to provide a useful tool to understand whether, when, and to whom dexamethasone should be administered during hospitalization for COVID-19. A post hoc analysis of data published in the preliminary report of the RECOVERY study was performed to calculate the person-based number needed to treat (NNT) and number needed to harm (NNH) of 6 mg dexamethasone once daily for up to 10 days vs. usual care with respect to mortality. At day 28, the NNT of dexamethasone vs. usual care was 36.0 (95%CI 24.9-65.1, < 0.05) in all patients, 8.3 (95%CI 6.0-13.1, < 0.05) in patients receiving invasive mechanical ventilation, and 34.6 (95%CI 22.1-79.0, < 0.05) in patients receiving oxygen only (with or without noninvasive ventilation). Dexamethasone increased mortality compared with usual care in patients not requiring oxygen supplementation, leading to a NNH value of 26.7 (95%CI 18.1-50.9, < 0.05). NNT of dexamethasone vs. usual care was 17.3 (95%CI 14.9-20.6) in subjects <70 years, 27.0 (95%CI 18.5-49.8) in men, and 16.2 (95%CI 13.2-20.8) in patients in which the onset of symptoms was >7 days. Dexamethasone is effective in male subjects < 70 years that require invasive mechanical ventilation experiencing symptoms from >7 days and those patients receiving oxygen without invasive mechanical ventilation; it should be avoided in patients not requiring respiratory support.
对新型冠状病毒肺炎治疗随机评估（RECOVERY）研究进行了临床解读，以提供一个有用的工具，来了解在新型冠状病毒肺炎住院期间，地塞米松是否、何时以及应给予何人使用。对RECOVERY研究初步报告中公布的数据进行了事后分析，以计算每日一次给予6毫克地塞米松，持续10天与常规治疗相比，在死亡率方面基于个体的治疗所需人数（NNT）和伤害所需人数（NNH）。在第28天，在所有患者中，地塞米松与常规治疗相比的NNT为36.0（95%CI 24.9 - 65.1，<0.05），在接受有创机械通气的患者中为8.3（95%CI 6.0 - 13.1，<0.05），在仅接受吸氧（无论有无无创通气）的患者中为34.6（95%CI 22.1 - 79.0，<0.05）。与常规治疗相比，地塞米松增加了不需要补充氧气患者的死亡率，导致NNH值为26.7（95%CI 18.1 - 50.9，<0.05）。在<70岁的受试者中，地塞米松与常规治疗相比的NNT为17.3（95%CI 14.9 - 20.6），在男性中为27.0（95%CI 18.5 - 49.8），在症状出现>7天的患者中为16.2（95%CI 13.2 - 20.8）。地塞米松对<70岁、需要有创机械通气、症状出现>7天的男性受试者以及那些接受吸氧但无有创机械通气的患者有效；对于不需要呼吸支持的患者应避免使用。
