Raymond Matthieu, Le Thuaut Aurélie, Asfar Pierre, Darreau Cédric, Reizine Florian, Colin Gwenhaël, Dano Charly, Lorber Julien, Hourmant Baptiste, Delbove Agathe, Frérou Aurélien, Morin Jean, Egreteau Pierre Yves, Seguin Philippe, Reignier Jean, Lascarrou Jean-Baptiste, Canet Emmanuel
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France.
Ann Intensive Care. 2022 Oct 29;12(1):102. doi: 10.1186/s13613-022-01074-w.
Dexamethasone is recommended for COVID-19 patients who require oxygen therapy. However, its effectiveness in reducing mortality and intubation, and its safety, remain debated. We aimed to investigate whether dexamethasone reduces day-28 mortality in unselected patients with critical COVID-19.
We performed an observational cohort study in consecutive COVID-19 patients admitted to any of 13 French intensive care units (ICUs) in 2020. The primary objective was to determine whether early dexamethasone therapy was associated with day-28 mortality and the secondary objectives were to assess whether early dexamethasone decreased intubation requirements and to collect adverse events.
Of 1058 included patients, 611 (57.75%) received early dexamethasone (early dexamethasone group), 358 (33.83%) did not receive any steroids (no steroids group), and 89 (8.41%) received late dexamethasone or other steroids. Day-28 mortality was similar between the early dexamethasone and the no steroids groups (15.06% and 14.25%, respectively; P = 0.59). Factors associated with day-28 mortality were older age (adjusted hazard ratio [aHR], 1.06; 1.04-1.09; P < 0.001), worse SOFA score (aHR, 1.13; 1.06-1.20; P < 0.001), and immunocompromised status (aHR, 1.59; 1.01-2.50; P = 0.043). Early dexamethasone was associated with fewer intubations (48.55% vs. 61.49%, P < 0.001) and more ventilator-free days by day 28 (22 [2-28] vs. 17 [1-28] days, P = 0.003), compared to no steroids. Ventilator-associated pneumonia (VAP) was more common with early dexamethasone (HR, 1.29 [1.01-1.63], P = 0.04) than with no steroids, whereas no differences were noted for bloodstream infection, fungal infection, or gastrointestinal bleeding.
Early dexamethasone in critically ill COVID-19 patients was not associated with lower day-28 mortality. However, early dexamethasone was associated with lower intubation needs and more ventilator-free days by day 28. In patients treated with invasive mechanical ventilation, early dexamethasone was associated with a higher risk of VAP.
地塞米松被推荐用于需要氧疗的新冠患者。然而，其在降低死亡率和插管率方面的有效性以及安全性仍存在争议。我们旨在研究地塞米松是否能降低未筛选的重症新冠患者28天死亡率。
我们于2020年在法国13个重症监护病房（ICU）之一连续收治的新冠患者中进行了一项观察性队列研究。主要目的是确定早期地塞米松治疗是否与28天死亡率相关，次要目的是评估早期地塞米松是否能减少插管需求并收集不良事件。
在纳入的1058例患者中，611例（57.75%）接受了早期地塞米松治疗（早期地塞米松组），358例（33.83%）未接受任何类固醇治疗（无类固醇组），89例（8.41%）接受了晚期地塞米松或其他类固醇治疗。早期地塞米松组和无类固醇组的28天死亡率相似（分别为15.06%和14.25%；P = 0.59）。与28天死亡率相关的因素包括年龄较大（调整后风险比[aHR]，1.06；1.04 - 1.09；P < 0.001）、序贯器官衰竭评估（SOFA）评分较差（aHR，1.13；1.06 - 1.20；P < 0.001）以及免疫功能低下状态（aHR，1.59；1.01 - 2.50；P = 0.043）。与无类固醇组相比，早期地塞米松治疗组的插管例数较少（48.55%对61.49%，P < 0.001），到第28天时无呼吸机天数更多（22[2 - 28]天对17[1 - 28]天，P = 0.003）。与无类固醇组相比，早期地塞米松治疗组呼吸机相关性肺炎（VAP）更常见（HR，1.29[1.01 - 1.63]，P = 0.04），而在血流感染、真菌感染或胃肠道出血方面未观察到差异。
重症新冠患者早期使用地塞米松与28天死亡率降低无关。然而，早期地塞米松与较低的插管需求和到第28天时更多的无呼吸机天数相关。在接受有创机械通气治疗的患者中，早期地塞米松与VAP风险较高相关。
