Department of Laboratory Medicine, Fujian Medical University, Fuzhou, Fujian, 350004, China.
Department of Gynecology and Obstetrics, 3rd People's Hospital of Yichang, Yichang, Hubei, 443000, China.
Respir Physiol Neurobiol. 2022 Mar;297:103813. doi: 10.1016/j.resp.2021.103813. Epub 2021 Nov 18.
This study was aimed to explore the precise dose of corticosteroid therapy in critical COVID-19. A total of forty-five critical COVID-19 patients were enrolled. The process of critical COVID-19 was divided into alveolitis and fibrosis stages. Most nonsurvivors died in fibrosis phase. Nonsurvivors had more dyspnea symptoms, fewer days of hospitalization, shorter duration of alveolitis and fibrosis. High-dose daily corticosteroid therapy (≥150 mg/d) was associated with shorter survival time and lower lymphocyte count in fibrosis phase. Moreover, a high cumulative dose (≥604 mg) was tied to longer duration of virus shedding, lower oxygenation index (OI), higher incidence of tracheal intubation, fewer lymphocytes and higher levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). In alveolitis phase, the low-to-moderate-dose daily corticosteroid therapy and a small cumulative dose reduced lymphocytes. In conclusion, low-to-moderate dose corticosteroids may be beneficial in the fibrosis phase. High-dose corticosteroid therapy in the fibrosis phase aggravates the severity of critical COVID-19.
本研究旨在探索治疗危重症 COVID-19 的精准皮质类固醇激素剂量。共纳入 45 例危重症 COVID-19 患者。危重症 COVID-19 过程分为肺泡炎和纤维化阶段。大多数非幸存者死于纤维化阶段。非幸存者呼吸困难症状更多，住院天数更少，肺泡炎和纤维化持续时间更短。纤维化阶段，大剂量（≥150mg/d）每日皮质类固醇激素治疗与生存时间更短和淋巴细胞计数更低有关。此外，高累积剂量（≥604mg）与病毒脱落时间更长、氧合指数（OI）更低、气管插管发生率更高、淋巴细胞更少以及 C 反应蛋白（CRP）和乳酸脱氢酶（LDH）水平更高有关。在肺泡炎阶段，低-中剂量每日皮质类固醇激素治疗和小累积剂量减少了淋巴细胞。总之，低-中剂量皮质类固醇激素可能对纤维化阶段有益。纤维化阶段大剂量皮质类固醇激素治疗加重危重症 COVID-19 的严重程度。
