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地塞米松使用对 COVID-19 患者病毒清除的影响:一项多中心队列研究。

Effects of dexamethasone use on viral clearance among patients with COVID-19: a multicenter cohort study.

机构信息

Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan.

Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan; Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.

出版信息

Int J Infect Dis. 2023 Mar;128:257-264. doi: 10.1016/j.ijid.2023.01.011. Epub 2023 Jan 13.

Abstract

OBJECTIVES

This study explored the outcomes and predictors of early viral clearance among patients with COVID-19.

METHODS

This study recruited consecutive patients from March 1, 2020 to July 31, 2021. Early viral clearance was defined as having a duration from symptom onset to successive detection of SARS-CoV-2 polymerase chain reaction cycle threshold (Ct) value of ≥30 within 10 days.

RESULTS

Among the 239 enrolled patients, 54.4% (130 patients) had early viral clearance. A multivariate logistic regression analysis identified that dexamethasone use and day 1 Ct values were independent factors associated with late viral clearance. Patients with mild-moderate severity and who received dexamethasone therapy had a longer time to viral clearance than those who did not receive dexamethasone (17.2 ± 1.8 days vs 12.3 ± 1.1 days, P = 0.018). Patients with severe-critical severity had a similar duration from symptom onset to Ct value ≥30, regardless of dexamethasone therapy (18.3 ± 0.9 days vs 16.7 ± 4.7 days, P = 0.626).

CONCLUSION

The study revealed that dexamethasone therapy and Ct values are independent predictors of late viral clearance. Patients with severe disease course due to older age, increased number of comorbidities, and worse clinical outcomes experienced delayed viral clearance.

摘要

目的

本研究探讨了 COVID-19 患者早期病毒清除的结果和预测因素。

方法

本研究于 2020 年 3 月 1 日至 2021 年 7 月 31 日连续招募患者。早期病毒清除定义为在 10 天内从症状发作到连续检测 SARS-CoV-2 聚合酶链反应循环阈值(Ct)值≥30 的时间间隔≥30 天。

结果

在 239 名入组患者中,54.4%(130 名)患者实现了早期病毒清除。多变量逻辑回归分析确定,地塞米松的使用和第 1 天的 Ct 值是与晚期病毒清除相关的独立因素。轻中度严重程度且接受地塞米松治疗的患者比未接受地塞米松治疗的患者病毒清除时间更长(17.2 ± 1.8 天比 12.3 ± 1.1 天,P = 0.018)。无论是否接受地塞米松治疗,严重-危急程度的患者从症状发作到 Ct 值≥30 的时间相似(18.3 ± 0.9 天比 16.7 ± 4.7 天,P = 0.626)。

结论

该研究表明,地塞米松治疗和 Ct 值是晚期病毒清除的独立预测因素。由于年龄较大、合并症较多和临床结局较差导致疾病严重程度较高的患者,病毒清除时间延迟。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d87/9837153/4f9dbd0e570a/gr1_lrg.jpg

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