Iglesias Jose I, Vassallo Andrew V, Sullivan Jesse B, Elbaga Yasmine, Patel Vishal V, Patel Nikunjkumar, Ayad Lydia, Benson Payam, Pittiglio Marina, Gobran Emad, Clark Alexander, Khan Wajahat, Damalas Kaliope, Mohan Rajesh, Singh Satyendra P
Department of Critical Care, Community Medical Center, Toms River, NJ 08757, United States.
Department of Pharmacy, Community Medical Center, Toms River, NJ 08757, United States.
World J Crit Care Med. 2021 Sep 9;10(5):244-259. doi: 10.5492/wjccm.v10.i5.244.
Our understanding of the severe acute respiratory syndrome coronavirus 2 has evolved since the first reported cases in December 2019, and a greater emphasis has been placed on the hyper-inflammatory response in severely ill patients. The purpose of this study was to determine risk factors for mortality and the impact of anti-inflammatory therapies on survival.
To determine the impact of various therapies on outcomes in severe coronavirus disease 2019 patients with a focus on anti-inflammatory and immune-modulating agents.
A retrospective analysis was conducted on 261 patients admitted or transferred to the intensive care unit in two community hospitals between March 12, 2020 and June 17, 2020. Totally 167 patients received glucocorticoid (GC) therapy. Seventy-three patients received GC alone, 94 received GC and tocilizumab, 28 received tocilizumab monotherapy, and 66 received no anti-inflammatory therapy.
Patient survival was associated with GC use, either alone or with tocilizumab, and decreased vasopressor requirements. Delayed administration of GC was found to decrease the survival benefit of GC therapy. No difference in survival was found with varying anticoagulant doses, convalescent plasma, tocilizumab monotherapy; prone ventilation, hydroxychloroquine, azithromycin, or intravenous ascorbic acid use.
This analysis demonstrated the survival benefit associated with anti-inflammatory therapy of GC, with or without tocilizumab, with the combination providing the most benefit. More studies are needed to assess the optimal timing of anti-inflammatory therapy initiation.
自2019年12月首次报告病例以来，我们对严重急性呼吸综合征冠状病毒2的认识不断发展，并且更加关注重症患者的过度炎症反应。本研究的目的是确定死亡风险因素以及抗炎治疗对生存的影响。
确定各种治疗方法对重症2019冠状病毒病患者预后的影响，重点关注抗炎和免疫调节药物。
对2020年3月12日至2020年6月17日期间在两家社区医院收治或转入重症监护病房的261例患者进行回顾性分析。共有167例患者接受了糖皮质激素（GC）治疗。73例患者单独接受GC治疗，94例接受GC联合托珠单抗治疗，28例接受托珠单抗单药治疗，66例未接受抗炎治疗。
患者生存与单独使用GC或GC联合托珠单抗治疗以及血管升压药需求减少相关。发现延迟给予GC会降低GC治疗的生存获益。不同抗凝剂量、恢复期血浆、托珠单抗单药治疗；俯卧位通气、羟氯喹、阿奇霉素或静脉使用维生素C，在生存方面未发现差异。
该分析表明，无论是否联合托珠单抗，GC抗炎治疗均具有生存获益，联合使用获益最大。需要更多研究来评估开始抗炎治疗的最佳时机。
