按皮质类固醇使用情况分层的新型冠状病毒2型所致院内死亡率
In-hospital mortality in SARS-CoV-2 stratified by the use of corticosteroid.
作者信息
Alotaibi Naser, Alroomi Moudhi, Aboelhassan Wael, Hussein Soumoud, Rajan Rajesh, AlNasrallah Noor, Al Saleh Mohammad, Ramadhan Maryam, Zhanna Kobalava D, Pan Jiazhu, Malhas Haya, Abdelnaby Hassan, Almutairi Farah, Al-Bader Bader, Alsaber Ahmad, Abdullah Mohammed
机构信息
Department of Medicine, Al Adan Hospital, Hadiya, Kuwait.
Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait.
出版信息
Ann Med Surg (Lond). 2022 Aug;80:104105. doi: 10.1016/j.amsu.2022.104105. Epub 2022 Jun 29.
OBJECTIVE
To investigate COVID-19 related mоrtаlity according to the use of corticosteroid therapy.
DESIGN
Retrospective cohort study.
SETTING
Two tertiary hospitals in Kuwait.
PARTICIPANTS
Overall, 962 patients with confirmed SARS-CoV-2 infection, were stratified according to whether they were treated with corticosteroids (dexamethasone or methylprednisolone). The mean age of the patients was 50.2 ± 15.9 years and 344/962 (35.9%) were female.
MAIN OUTCOME MEASURES
In-hospital mortality and cumulative all-cause mortality.
RESULTS
Compared to non-corticosteroid therapy patients, corticosteroid therapy patients had a higher prevalence of hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, and chronic kidney disease; a longer hospital stay (median [IQR]: 17.0 [5.0-57.3] days vs 14.0 [2.0-50.2] days); and a higher in-hospital mortality (51/199 [25.6%] vs 36/763 [4.7%]). Logistic regression analysis showed a higher in-hospital mortality in the corticosteroid group (adjusted odds ratio [aOR]: 4.57, 95% confidence interval [CI]: 2.64-8.02, p < 0.001). Cox proportional hazards regression showed that corticosteroid use was a significant predictor of mortality (hazard ratio [HR]: 3.96, p < 0.001).
CONCLUSIONS
In-hospital mortality in patients with SARS-CoV-2 on corticosteroid therapy was 4.6 times higher than in those without corticosteroid therapy.
目的
根据皮质类固醇疗法的使用情况调查新型冠状病毒肺炎（COVID-19）相关死亡率。
设计
回顾性队列研究。
地点
科威特的两家三级医院。
参与者
总体而言，962例确诊感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的患者，根据是否接受皮质类固醇（地塞米松或甲泼尼龙）治疗进行分层。患者的平均年龄为50.2±15.9岁，344/962（35.9%）为女性。
主要观察指标
住院死亡率和累积全因死亡率。
结果
与未接受皮质类固醇治疗的患者相比，接受皮质类固醇治疗的患者高血压、糖尿病、心血管疾病、慢性肺病和慢性肾病的患病率更高；住院时间更长（中位数[四分位间距]：17.0[5.0 - 57.3]天对14.0[2.0 - 50.2]天）；住院死亡率更高（51/199[25.6%]对36/763[4.7%]）。逻辑回归分析显示皮质类固醇组的住院死亡率更高（调整优势比[aOR]：4.57，95%置信区间[CI]：2.64 - 8.02，p<0.001）。Cox比例风险回归显示使用皮质类固醇是死亡率的显著预测因素（风险比[HR]：3.96，p<0.001）。
结论
接受皮质类固醇治疗的SARS-CoV-2患者的住院死亡率比未接受皮质类固醇治疗的患者高4.6倍。
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