皮质类固醇类药物是重症监护患者 COVID-19 相关肺曲霉病的危险因素。
Corticosteroids as risk factor for COVID-19-associated pulmonary aspergillosis in intensive care patients.
机构信息
Division of Gastroenterology, Infectious Diseases and Rheumatology, Medical Department, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
出版信息
Crit Care. 2022 Jan 28;26(1):30. doi: 10.1186/s13054-022-03902-8.
PURPOSE
Corticosteroids, in particular dexamethasone, are one of the primary treatment options for critically ill COVID-19 patients. However, there are a growing number of cases that involve COVID-19-associated pulmonary aspergillosis (CAPA), and it is unclear whether dexamethasone represents a risk factor for CAPA. Our aim was to investigate a possible association of the recommended dexamethasone therapy with a risk of CAPA.
METHODS
We performed a study based on a cohort of COVID-19 patients treated in 2020 in our 13 intensive care units at Charité Universitätsmedizin Berlin. We used ECMM/ISHM criteria for the CAPA diagnosis and performed univariate and multivariable analyses of clinical parameters to identify risk factors that could result in a diagnosis of CAPA.
RESULTS
Altogether, among the n = 522 intensive care patients analyzed, n = 47 (9%) patients developed CAPA. CAPA patients had a higher simplified acute physiology score (SAPS) (64 vs. 53, p < 0.001) and higher levels of IL-6 (1,005 vs. 461, p < 0.008). They more often had severe acute respiratory distress syndrome (ARDS) (60% vs. 41%, p = 0.024), renal replacement therapy (60% vs. 41%, p = 0.024), and they were more likely to die (64% vs. 48%, p = 0.049). The multivariable analysis showed dexamethasone (OR 3.110, CI95 1.112-8.697) and SAPS (OR 1.063, CI95 1.028-1.098) to be independent risk factors for CAPA.
CONCLUSION
In our study, dexamethasone therapy as recommended for COVID-19 was associated with a significant three times increase in the risk of CAPA.
TRIAL REGISTRATION
Registration number DRKS00024578, Date of registration March 3rd, 2021.
目的
皮质类固醇，特别是地塞米松，是治疗危重新冠肺炎患者的主要治疗方法之一。然而，越来越多的病例涉及 COVID-19 相关肺曲霉病（CAPA），目前尚不清楚地塞米松是否是 CAPA 的危险因素。我们的目的是研究推荐的地塞米松治疗与 CAPA 风险之间可能存在的关联。
方法
我们基于在柏林夏洛蒂医科大学的 13 个重症监护病房中于 2020 年接受治疗的 COVID-19 患者队列进行了一项研究。我们使用 ECMM/ISHM 标准诊断 CAPA，并对临床参数进行单变量和多变量分析，以确定可能导致 CAPA 诊断的危险因素。
结果
在总共分析的 522 名重症监护患者中，有 47 名（9%）患者发生了 CAPA。CAPA 患者的简化急性生理学评分（SAPS）更高（64 比 53，p<0.001），白细胞介素 6（IL-6）水平更高（1005 比 461，p<0.008）。他们更常发生严重急性呼吸窘迫综合征（ARDS）（60%比 41%，p=0.024）、肾脏替代治疗（60%比 41%，p=0.024），并且死亡风险更高（64%比 48%，p=0.049）。多变量分析显示，地塞米松（OR 3.110，95%CI95 1.112-8.697）和 SAPS（OR 1.063，95%CI95 1.028-1.098）是 CAPA 的独立危险因素。
结论
在我们的研究中，推荐用于 COVID-19 的地塞米松治疗与 CAPA 风险显著增加三倍相关。
临床试验注册
注册号 DRKS00024578，注册日期 2021 年 3 月 3 日。
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