Ro Shosei, Nishimura Naoki, Imai Ryosuke, Tomishima Yutaka, So Clara, Murakami Manabu, Okafuji Kohei, Kitamura Atsushi, Jinta Torahiko, Tamura Tomohide
Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
Multidiscip Respir Med. 2021 Jun 30;16(1):781. doi: 10.4081/mrm.2021.781. eCollection 2021 Jan 15.
Corticosteroids have been reported to reduce the mortality rates in patients with coronavirus disease 2019 (COVID-19). Additionally, the role of high-dose methylprednisolone pulse therapy in reducing mortality in critically ill patients has also been documented. The purpose of this study is to identify patients with COVID-19 who are suitable for methylprednisolone pulse therapy.
This was a retrospective study that included patients with COVID-19 receiving methylprednisolone pulse therapy (≥250 mg/day for 3 days) with subsequent tapering doses at our hospital between June 2020 and January 2021. We examined the differences in background clinical factors between the surviving group and the deceased group.
Out of 156 patients who received steroid therapy, 17 received methylprednisolone pulse therapy. Ten patients recovered (surviving group) and seven patients died (deceased group). The median age of the surviving and deceased groups was 64.5 years (range, 57-85) and 79 years (73-90), respectively, with a significant difference (p=0.004). Five of the deceased patients (71%) had developed serious complications associated with the cause of death, including pneumothorax, pneumomediastinum, COVID-19-associated pulmonary aspergillosis, cytomegalovirus infection, and bacteremia. On the other hand, out of the 10 survivors, only one elderly person had cytomegalovirus infection and the rest recovered without complications.
Administration of methylprednisolone pulse therapy with subsequent tapering may be an effective treatment in patients with COVID-19 up to the age of early 70s; however, severe complications may be seen in elderly patients.
据报道，皮质类固醇可降低2019冠状病毒病（COVID-19）患者的死亡率。此外，大剂量甲泼尼龙冲击疗法在降低重症患者死亡率方面的作用也已得到证实。本研究的目的是确定适合甲泼尼龙冲击疗法的COVID-19患者。
这是一项回顾性研究，纳入了2020年6月至2021年1月期间在我院接受甲泼尼龙冲击疗法（≥250mg/天，共3天）并随后逐渐减量的COVID-19患者。我们研究了存活组和死亡组之间背景临床因素的差异。
在156例接受类固醇治疗的患者中，17例接受了甲泼尼龙冲击疗法。10例患者康复（存活组），7例患者死亡（死亡组）。存活组和死亡组的中位年龄分别为64.5岁（范围57-85岁）和79岁（73-90岁），差异有统计学意义（p=0.004）。5例死亡患者（71%）出现了与死亡原因相关的严重并发症，包括气胸、纵隔气肿、COVID-19相关肺曲霉病、巨细胞病毒感染和菌血症。另一方面，在10名幸存者中，只有一名老年人有巨细胞病毒感染，其余患者均无并发症康复。
对于70岁出头及以下的COVID-19患者，给予甲泼尼龙冲击疗法并随后逐渐减量可能是一种有效的治疗方法；然而，老年患者可能会出现严重并发症。
