Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea.
Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
J Korean Med Sci. 2022 Jul 25;37(29):e228. doi: 10.3346/jkms.2022.37.e228.
BACKGROUND: Glucocorticoids are one of the current standard agents for moderate to severe coronavirus disease 2019 (COVID-19) treatment based on the RECOVERY trial. Data on the real clinical application of steroids for COVID-19 are scarce and will help guide the optimal use of steroids. We described the current prescription pattern of steroids for COVID-19 and investigated the factors related to specific practices. METHODS: All adults aged ≥ 19 years who were diagnosed with COVID-19 by real-time reverse transcription-polymerase chain reaction and admitted to one of 3 study hospitals from 8 December 2020 to 30 June 2021 were enrolled. Demographic and clinical data, including medications and oxygen therapy, were retrospectively collected from electronic medical records. The severity of comorbidities and COVID-19 were measured. The subjects were divided into steroid and nonsteroid groups, and the steroid group was then subdivided into standard and higher/longer groups. RESULTS: Among a total of 805 patients, 217 (27.0%) were treated with steroids. The steroid group showed a higher rate of oxygen therapy (81.1% vs. 2.7%), more concomitant use of remdesivir (77.4% vs. 1.4%) or antibiotics (79.3% vs. 4.3%), and a higher proportion of high risk according to National Early Warning Score-2 score (30.0% vs. 0.9%) or severe risk according to National Institute of Allergy and Infectious Disease Ordinal Scale score (81.1% vs. 2.7%) than the nonsteroid group. The mortality of the steroid group was 4.6%. In the steroid group, 82.5% received a standard or lower dose of steroids within ten days, and 17.5% (38/217) received a higher or longer dose of steroids. Multivariate analysis showed that initial lymphopenia (adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.89-0.99) and high level of lactate dehydrogenase (LDH) (aOR, 1.00; 95% CI, 1.00-1.01) were independent risk factors for higher doses or longer steroid use. CONCLUSION: The dose and duration of steroids were in line with current guidelines in 82.5% of COVID-19 patients, but the outliers may need tailored therapy according to surrogate markers, such as initial lymphopenia or high level of LDH.
背景：基于 RECOVERY 试验，糖皮质激素是目前治疗中度至重度 2019 年冠状病毒病（COVID-19）的标准药物之一。关于皮质类固醇治疗 COVID-19 的实际临床应用的数据很少，这将有助于指导皮质类固醇的最佳使用。我们描述了 COVID-19 中皮质类固醇的当前处方模式，并研究了与具体实践相关的因素。
方法：所有年龄≥19 岁的成年人，通过实时逆转录聚合酶链反应诊断为 COVID-19，并于 2020 年 12 月 8 日至 2021 年 6 月 30 日期间从 3 家研究医院之一入院，均纳入本研究。从电子病历中回顾性收集人口统计学和临床数据，包括药物和氧疗。测量合并症和 COVID-19 的严重程度。将受试者分为类固醇组和非类固醇组，然后将类固醇组进一步分为标准剂量和高剂量/长疗程组。
结果：共纳入 805 例患者，其中 217 例（27.0%）接受了类固醇治疗。与非类固醇组相比，类固醇组的氧疗率更高（81.1% vs. 2.7%），更常联合使用瑞德西韦（77.4% vs. 1.4%）或抗生素（79.3% vs. 4.3%），根据国家早期预警评分-2 评分（30.0% vs. 0.9%）或国家过敏和传染病研究所等级评分（81.1% vs. 2.7%），高危或严重风险的比例更高。类固醇组的死亡率为 4.6%。在类固醇组中，82.5%的患者在 10 天内接受了标准或低剂量的类固醇治疗，17.5%（38/217）接受了高剂量或长疗程的类固醇治疗。多变量分析显示，初始淋巴细胞减少（调整优势比[aOR]，0.94；95%置信区间[CI]，0.89-0.99）和乳酸脱氢酶（LDH）水平升高（aOR，1.00；95%CI，1.00-1.01）是接受更高剂量或更长疗程类固醇治疗的独立危险因素。
结论：COVID-19 患者中 82.5%的皮质类固醇剂量和疗程符合当前指南，但根据替代标志物（如初始淋巴细胞减少或 LDH 水平升高），可能需要对异常值进行个体化治疗。
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