Colaneri Marta, Lissandrin Raffaella, Calia Matteo, Bassoli Cecilia, Seminari Elena, Pavesi Alessandro, Rovida Francesca, Baldanti Fausto, Muzzi Alba, Chichino Guido, Regazzetti Angelo, Grecchi Cecilia, Pan Angelo, Lupi Matteo, Franceschini Erica, Mussini Cristina, Bruno Raffaele
Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Open Forum Infect Dis. 2023 Feb 20;10(3):ofad092. doi: 10.1093/ofid/ofad092. eCollection 2023 Mar.
The use of steroid therapy in potentially life-threatening neuroinvasive forms of West Nile infection (WNND) is controversial. The aim of this study is to assess the efficacy of steroid therapy in reducing intrahospital mortality, length of stay, and neurological sequelae at discharge.
This was a multicenter, retrospective, observational study conducted in 5 hospitals in Northern Italy, headed by the Fondazione IRCSS Policlinico San Matteo (Pavia). We extracted all patient data with WNND diagnoses, comparing patients who received steroid treatment with patients who did not receive steroid treatment between January 2014 and January 2022. Comparisons between the 2 groups were performed using chi-square tests for categorical variables and Mann-Whitney tests for non-normal continuous data, and a generalized linear model for the binomial family was carried out.
Data from 65 WNND patients were extracted. Among these patients, 33 (50.7%) received steroid therapy at any point during their hospitalization. Receiving steroid therapy did not significantly reduce intrahospital mortality (odds ratio [OR], 1.70; 95% CI, 0.3-13.8; = .89) or neurological sequelae at discharge (OR, 0.53; 95% CI, 0.16-1.76; = .47).
Steroid treatment is currently used on a single-case basis in severe WNND. More prospective data are needed to demonstrate a protective effect on mortality and neurological sequelae.
在西尼罗河病毒感染的潜在危及生命的神经侵袭性形式（WNND）中使用类固醇疗法存在争议。本研究的目的是评估类固醇疗法在降低院内死亡率、住院时间和出院时神经后遗症方面的疗效。
这是一项在意大利北部5家医院进行的多中心、回顾性、观察性研究，由圣马泰奥综合医院基金会（帕维亚）牵头。我们提取了所有诊断为WNND的患者数据，比较了2014年1月至2022年1月期间接受类固醇治疗的患者和未接受类固醇治疗的患者。两组之间的比较采用卡方检验分析分类变量，采用曼-惠特尼检验分析非正态连续数据，并进行了二项式族的广义线性模型分析。
提取了65例WNND患者的数据。在这些患者中，33例（50.7%）在住院期间的任何时候接受了类固醇治疗。接受类固醇治疗并没有显著降低院内死亡率（优势比[OR]，1.70；95%置信区间，0.3 - 13.8；P = 0.89）或出院时的神经后遗症（OR，0.53；95%置信区间，0.16 - 1.76；P = 0.47）。
目前在严重WNND中，类固醇治疗是基于个案使用的。需要更多前瞻性数据来证明其对死亡率和神经后遗症的保护作用。
