School of Population Health and Environmental Sciences, King's College London, London, UK.
Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK.
BMC Infect Dis. 2022 Oct 5;22(1):776. doi: 10.1186/s12879-022-07750-3.
Randomised controlled trials have shown that steroids reduce the risk of dying in patients with severe Coronavirus disease 2019 (COVID-19), whilst many real-world studies have failed to replicate this result. We aim to investigate real-world effectiveness of steroids in severe COVID-19.
Clinical, demographic, and viral genome data extracted from electronic patient record (EPR) was analysed from all SARS-CoV-2 RNA positive patients admitted with severe COVID-19, defined by hypoxia at presentation, between March 13th 2020 and May 27th 2021. Steroid treatment was measured by the number of prescription-days with dexamethasone, hydrocortisone, prednisolone or methylprednisolone. The association between steroid > 3 days treatment and disease outcome was explored using multivariable cox proportional hazards models with adjustment for confounders (including age, gender, ethnicity, co-morbidities and SARS-CoV-2 variant). The outcome was in-hospital mortality.
1100 severe COVID-19 cases were identified having crude hospital mortality of 15.3%. 793/1100 (72.1%) individuals were treated with steroids and 513/1100 (46.6%) received steroid ≤ 3 days. From the multivariate model, steroid > 3 days was associated with decreased hazard of in-hospital mortality (HR: 0.47 (95% CI: 0.31-0.72)).
The protective effect of steroid treatment for severe COVID-19 reported in randomised clinical trials was replicated in this retrospective study of a large real-world cohort.
随机对照试验表明，类固醇可降低重症 2019 冠状病毒病（COVID-19）患者的死亡风险，而许多真实世界的研究未能复制这一结果。我们旨在研究类固醇在重症 COVID-19 中的实际疗效。
从 2020 年 3 月 13 日至 2021 年 5 月 27 日期间因缺氧而入院的所有 SARS-CoV-2 RNA 阳性、患有严重 COVID-19 的患者的电子病历（EPR）中提取临床、人口统计学和病毒基因组数据。类固醇治疗通过地塞米松、氢化可的松、泼尼松或甲泼尼龙的处方天数来衡量。使用多变量 Cox 比例风险模型，调整混杂因素（包括年龄、性别、种族、合并症和 SARS-CoV-2 变异），探讨类固醇治疗>3 天与疾病结局的关联。结局是院内死亡率。
共确定了 1100 例严重 COVID-19 病例，粗住院死亡率为 15.3%。1100 例中有 793 例（72.1%）接受了类固醇治疗，513 例（46.6%）接受了类固醇治疗≤3 天。从多变量模型来看，类固醇治疗>3 天与降低院内死亡率的风险相关（HR：0.47（95%CI：0.31-0.72））。
这项大型真实世界队列的回顾性研究复制了随机临床试验报告的类固醇治疗对重症 COVID-19 的保护作用。
