Germany Department of Respiratory Diseases, Lungenklinik Heckeshorn, Helios Hospital Emil-von-Behring, 14165 Berlin, Germany.
Department of Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany.
Viruses. 2023 Apr 28;15(5):1076. doi: 10.3390/v15051076.
Even though several therapeutic options are available, COVID-19 is still lacking a specific treatment regimen. One potential option is dexamethasone, which has been established since the early beginnings of the pandemic. The aim of this study was to determine its effects on the microbiological findings in critically ill COVID-19 patients.
A multi-center, retrospective study was conducted, in which all the adult patients who had a laboratory-confirmed (PCR) SARS-CoV-2 infection and were treated on intensive care units in one of twenty hospitals of the German Helios network between February 2020-March 2021 were included. Two cohorts were formed: patients who received dexamethasone and those who did not, followed by two subgroups according to the application of oxygen: invasive vs. non-invasive.
The study population consisted of 1.776 patients, 1070 of whom received dexamethasone, and 517 (48.3%) patients with dexamethasone were mechanically ventilated, compared to 350 (49.6%) without dexamethasone. Ventilated patients with dexamethasone were more likely to have any pathogen detection than those without ( < 0.026; OR = 1.41; 95% CI 1.04-1.91). A significantly higher risk for the respiratory detection of ( = 0.016; OR = 1.68 95% CI 1.10-2.57) and for ( = 0.008; OR = 1.57; 95% CI 1.12-2.19) was found for the dexamethasone cohort. Invasive ventilation was an independent risk factor for in-hospital mortality ( < 0.01; OR = 6.39; 95% CI 4.71-8.66). This risk increased significantly in patients aged 80 years or older by 3.3-fold ( < 0.01; OR = 3.3; 95% CI 2.02-5.37) when receiving dexamethasone.
Our results show that the decision to treat COVID-19 patients with dexamethasone should be a matter of careful consideration as it involves risks and bacterial shifts.
尽管有几种治疗选择，但 COVID-19 仍然缺乏特定的治疗方案。一种潜在的选择是地塞米松，它自大流行早期就已确立。本研究的目的是确定其对危重症 COVID-19 患者微生物学发现的影响。
进行了一项多中心回顾性研究，纳入了 2020 年 2 月至 2021 年 3 月期间德国 Helios 网络 20 家医院的重症监护病房治疗的实验室确诊（PCR）SARS-CoV-2 感染的所有成年患者。形成了两个队列：接受地塞米松治疗的患者和未接受地塞米松治疗的患者，然后根据氧气的应用分为两个亚组：有创与无创。
研究人群包括 1776 名患者，其中 1070 名接受了地塞米松治疗，517 名（48.3%）地塞米松治疗的患者需要机械通气，而未接受地塞米松治疗的患者为 350 名（49.6%）。接受地塞米松治疗的机械通气患者比未接受地塞米松治疗的患者更有可能检测到任何病原体（<0.026；OR=1.41；95%CI 1.04-1.91）。地塞米松组患者呼吸检测到的 （=0.016；OR=1.68；95%CI 1.10-2.57）和 （=0.008；OR=1.57；95%CI 1.12-2.19）的风险显著增加。有创通气是住院死亡率的独立危险因素（<0.01；OR=6.39；95%CI 4.71-8.66）。在接受地塞米松治疗的 80 岁或以上患者中，该风险显著增加了 3.3 倍（<0.01；OR=3.3；95%CI 2.02-5.37）。
我们的结果表明，用地塞米松治疗 COVID-19 患者的决定应该慎重考虑，因为这涉及风险和细菌转移。
