Department of Pulmonology, Zuyderland Medical Centre, Heerlen, The Netherlands
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
RMD Open. 2021 Nov;7(3). doi: 10.1136/rmdopen-2021-001906.
To prospectively investigate differences in medium-term patient-reported outcome measures and objective functional outcome measures, between patients receiving and those not receiving intensive short-term immunosuppressive therapy for coronavirus disease 19 (COVID-19)-associated hyperinflammation.
Patients previously included in the COVID-19 High-intensity Immunosuppression in Cytokine storm syndrome (CHIC) study who received immunosuppressive treatment versus standard of care for COVID-19-associated hyperinflammation were invited for follow-up at 3 and 6 months after hospitalisation. At both visits, patients were assessed by a pulmonologist, completed quality of life (QoL) questionnaires and performed pulmonary and exercise function tests. At 3 months, patients additionally completed questionnaires on dyspnoea, anxiety, depression and trauma. Outcomes were compared between patients receiving and those not receiving intensive short-term immunosuppressive therapy for COVID-19-associated hyperinflammation.
131 (66.5%) patients survived hospitalisation due to COVID-19-associated hyperinflammation and 118 (90.1%) were included. QoL questionnaires, pulmonary- and exercise function tests showed improvement between 3 and 6 months after discharge, which was similar in both groups. Assessed patients reached levels that were close to levels predicted from the normal population. In contrast, diffusing capacity of the lung for carbon monoxide was disturbed in both groups: 69.6% predicted (SD 16.2) and 73.5% predicted (SD 16.5) in control group and treated group, respectively.
No differences in medium-term outcomes are demonstrated in survivors of COVID-19-associated hyperinflammation treated or not treated with methylprednisolone with or without tocilizumab during the acute phase. Short-term benefits of this therapy, as showed in the baseline CHIC study analysis, are thus not hampered by medium-term adverse events.
前瞻性研究接受与未接受新冠肺炎相关过度炎症强化短期免疫抑制治疗的患者之间中期患者报告结局指标和客观功能结局指标的差异。
先前纳入 COVID-19 高免疫抑制治疗细胞因子风暴综合征（CHIC）研究的患者，因 COVID-19 相关过度炎症接受免疫抑制治疗与 COVID-19 相关过度炎症的标准治疗相比，被邀请在住院后 3 个月和 6 个月进行随访。在两次就诊时，患者均由肺病专家进行评估，完成生活质量（QoL）问卷并进行肺功能和运动功能测试。在 3 个月时，患者还完成了呼吸困难、焦虑、抑郁和创伤问卷。比较了接受和未接受强化短期免疫抑制治疗的 COVID-19 相关过度炎症患者之间的结局。
131 例（66.5%）因 COVID-19 相关过度炎症住院患者存活，其中 118 例（90.1%）纳入研究。出院后 3 至 6 个月 QoL 问卷、肺功能和运动功能测试均有所改善，两组间无差异。评估患者的水平接近正常人群的预测值。相反，两组的一氧化碳弥散量均存在异常：对照组为预计值的 69.6%（SD 16.2），治疗组为预计值的 73.5%（SD 16.5）。
在因 COVID-19 相关过度炎症住院的患者中，无论是否在急性期接受甲基泼尼松龙联合或不联合托珠单抗治疗，均未显示出中期结局存在差异。这种治疗的短期获益，如基线 CHIC 研究分析所示，并未因中期不良事件而受到阻碍。
