ISARIC WHO 临床特征方案英国：前瞻性、队列研究中皮质类固醇在 COVID-19 治疗中的应用。
Implementation of corticosteroids in treatment of COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK: prospective, cohort study.
机构信息
College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, London, UK.
出版信息
Lancet Digit Health. 2022 Apr;4(4):e220-e234. doi: 10.1016/S2589-7500(22)00018-8.
BACKGROUND
Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care.
METHODS
We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260.
FINDINGS
Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70-0·89], p=0·0001, for 70-79 years; 0·52 [0·46-0·58], p<0·0001, for >80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75-80% in January, 2021.
INTERPRETATION
Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered.
FUNDING
UK National Institute for Health Research and UK Medical Research Council.
背景
地塞米松是首个被证明能降低住院 COVID-19 患者死亡率的干预措施。我们旨在评估 2020 年 6 月 16 日 RECOVERY 试验公布后，在英国 COVID-19 治疗中皮质类固醇的应用情况，并确定治疗中的差异。
方法
我们在 2020 年 3 月 16 日至 2021 年 4 月 14 日期间，对 237 家英国急性护理医院进行了一项前瞻性、观察性、队列研究，评估皮质类固醇在 COVID-19 患者中的临床应用情况，这些患者年龄在 18 岁及以上，有明确或高度可能的 COVID-19 证据，并接受补充氧气治疗。主要结局是地塞米松、泼尼松龙、氢化可的松或甲泼尼龙的应用。本研究在 ISRCTN 和 ISRCTN66726260 注册。
结果
在 2020 年 6 月 17 日至 2021 年 4 月 14 日期间，在接受补充氧气的 63525 名患者中，有 47979 名（75.2%）接受了皮质类固醇治疗，在需要重症监护的患者中，皮质类固醇的使用率高于在接受病房护理的患者中（11185 名[86.6%]比 36415 名[72.4%]）。50 岁及以上的患者接受皮质类固醇治疗的可能性显著低于 50 岁以下的患者（调整后的优势比 0.79 [95%CI 0.70-0.89]，p=0.0001，70-79 岁；0.52 [0.46-0.58]，p<0.0001，>80 岁），与患者的人口统计学特征和疾病严重程度无关。155 名孕妇中有 84 名（54.2%）接受了皮质类固醇治疗。皮质类固醇治疗的使用率从 2020 年 6 月 16 日前一周的 27.5%上升到 2021 年 1 月的 75-80%。
结论
皮质类固醇在英国 COVID-19 患者的临床实践中的应用已经取得了成功，但还没有普及。70 岁以上的患者，无论疾病严重程度、慢性神经系统疾病和痴呆如何，接受皮质类固醇治疗的可能性都低于年轻患者，孕妇也是如此。这可能反映了适当的临床决策，但也应该考虑到获得救命治疗的机会不平等。
资金
英国国家卫生研究院和英国医学研究理事会。
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