Nasa Prashant, Chaudhry Dhruva, Govil Deepak, Daga Mradul K, Jain Ravi, Chhallani Akshaykumar A, Krishna Apoorv, Jagiasi Bharat G, Juneja Deven, Barthakur Himadri S, Jha Hrishikesh, Gurjar Mohan, Rangappa Pradeep, Aladakatti Raghunath, Mishra Rajesh C, Shetty Rajesh M, Yadav Rohit, Garg Sandeep, Nandakumar Sivakumar M, Samavedam Srinivas, Ray Sumit, Hadda Vijay, Javeri Yash, Munjal Manish
Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates.
Professor and Head, Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India.
Indian J Crit Care Med. 2021 Nov;25(11):1280-1285. doi: 10.5005/jp-journals-10071-23923.
There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-severe COVID-19 who may benefit from using corticosteroids.
A modified Delphi was conducted with two anonymous surveys between April 30, 2021, and May 3, 2021. An expert panel of 35 experts was selected and invited to participate through e-mail. The consensus was defined as >70% votes in multiple-choice questions (MCQ) on Likert-scale type statements, while strong consensus as >90% votes in MCQ or >50% votes for "very important" on Likert-scale questions in the final round.
Twenty experts completed two rounds of the survey. There was strong consensus for the increased work of breathing (95%), a positive six-minute walk test (90%), thorax computed tomography severity score of >14/25 (85%), new-onset organ dysfunction (using clinical or biochemical criteria) (80%), and C-reactive protein >5 times the upper limit of normal (70%) as the criteria for patients' selection. The experts recommended using oral or intravenous (IV) low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days and monitoring of oxygen saturation, body temperature, clinical scoring system, blood sugar, and inflammatory markers for any "red-flag" signs.
The experts recommended against indiscriminate use of corticosteroids in mild to moderate COVID-19 without the signs of clinical worsening. Oral or IV low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days are recommended for patients with features of disease progression based on clinical, biochemical, or radiological criteria after 5 days from symptom onset under close monitoring.
How to cite this article: Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, et al. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11):1280-1285.
有充分证据表明皮质类固醇可用于治疗重症2019冠状病毒病（COVID-19）。然而，关于皮质类固醇的使用时机仍存在不确定性。我们进行了一项改良的德尔菲研究，以就早期识别非重症COVID-19患者中可能从使用皮质类固醇中获益的亚组制定专家共识声明。
在2021年4月30日至2021年5月3日期间进行了两轮匿名的改良德尔菲调查。通过电子邮件挑选并邀请了一个由35名专家组成的专家小组参与。在李克特量表类型的陈述的多项选择题（MCQ）中，共识被定义为超过70%的投票，而在最后一轮中，在MCQ中超过90%的投票或在李克特量表问题中对于“非常重要”超过50%的投票被定义为强烈共识。
20名专家完成了两轮调查。对于呼吸功增加（95%）、六分钟步行试验阳性（90%）、胸部计算机断层扫描严重程度评分>14/25（85%）、新发器官功能障碍（使用临床或生化标准）（80%）以及C反应蛋白>正常上限5倍（70%）作为患者选择标准达成了强烈共识。专家们建议使用口服或静脉注射（IV）低剂量皮质类固醇（相当于6毫克/天的地塞米松）5至10天，并监测血氧饱和度、体温、临床评分系统、血糖和炎症标志物，以发现任何“警示”体征。
专家们建议在无临床恶化迹象的轻至中度COVID-19中不要滥用皮质类固醇。对于症状出现5天后根据临床、生化或放射学标准有疾病进展特征的患者，建议在密切监测下口服或静脉注射低剂量皮质类固醇（相当于6毫克/天的地塞米松）5至10天。
如何引用本文：纳萨P、乔杜里D、戈维尔D、达加MK、贾恩R、查拉尼AA等。关于非重症COVID-19中皮质类固醇使用的专家共识声明。《印度重症监护医学杂志》2021；25（11）：1280 - 1285。
