Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
Department of Anesthesiology and Reanimation/Intensive Care, Health Sciences University Kartal Dr. Lutfi Kırdar Training and Research Hospital, Istanbul, Turkey.
J Korean Med Sci. 2023 Jul 24;38(29):e232. doi: 10.3346/jkms.2023.38.e232.
Coronavirus disease 2019 (COVID-19) is often a mild disease, usually manifesting with respiratory complaints, and is sometimes mortal due to multiple organ failure. Hyperinflammation is a known COVID-19 component and is associated with organ dysfunction, disease severity and mortality. Controlling hyperinflammatory response is crucial in determining treatment direction. An important agent in providing this control is corticosteroids. This study aimed to determine whether dexamethasone and methylprednisolone, doses, administration time and duration in COVID-19 treatment are associated with improved treatment outcomes.
This retrospective multicenter study was conducted with participation of 6 healthcare centers which collected data by retrospectively examining files of 1,340 patients admitted to intensive care unit due to COVID-19 between March 2020 and September 2021, diagnosed with polymerase chain reaction (+) and/or clinically and radiologically.
Mortality in the pulse methylprednisolone group was statistically significantly higher than that in the other 3 groups. Mortality was higher in older patients with comorbidities such as hypertension, diabetes mellitus, chronic kidney failure, coronary artery disease, and dementia. Pulse and mini-pulse steroid doses were less effective than standard methylprednisolone and dexamethasone doses, pulse steroid doses being associated with high mortality. Standard-dose methylprednisolone and dexamethasone led to similar effects, but standard dose methylprednisolone was more effective in severe patients who required mechanical ventilation (MV). Infection development was related to steroid treatment duration, not cumulative steroid dose.
Corticosteroids are shown to be beneficial in critical COVID-19, but the role of early corticosteroids in mild COVID-19 patients remains unclear. The anti-inflammatory effects of corticosteroids may have a positive effect by reducing mortality in severe COVID-19 patients. Although dexamethasone was first used for this purpose, methylprednisolone was found to be as effective at standard doses. Methylprednisolone administered at standard doses was associated with greater PaO/FiO ratios than dexamethasone, especially in the severe group requiring MV. High dose pulse steroid doses are closely associated with mortality and standard methylprednisolone dose is recommended.
新型冠状病毒病 2019（COVID-19）通常是一种轻度疾病，通常表现为呼吸道症状，有时由于多器官衰竭而致命。过度炎症是 COVID-19 的已知组成部分，与器官功能障碍、疾病严重程度和死亡率有关。控制过度炎症反应对于确定治疗方向至关重要。皮质类固醇是提供这种控制的重要药物。本研究旨在确定 COVID-19 治疗中地塞米松和甲基强的松龙的剂量、给药时间和持续时间是否与改善治疗结果相关。
这是一项回顾性多中心研究，共有 6 家医疗中心参与，这些中心通过回顾性检查 2020 年 3 月至 2021 年 9 月期间因 COVID-19 入住重症监护病房的 1340 名患者的文件来收集数据，这些患者通过聚合酶链反应（+）和/或临床和放射学诊断。
脉冲甲基强的松龙组的死亡率明显高于其他 3 组。高血压、糖尿病、慢性肾衰竭、冠心病和痴呆等合并症的老年患者死亡率更高。脉冲和迷你脉冲类固醇剂量不如标准甲基强的松龙和地塞米松剂量有效，脉冲类固醇剂量与高死亡率相关。标准剂量甲基强的松龙和地塞米松导致类似的效果，但标准剂量甲基强的松龙在需要机械通气（MV）的重症患者中更有效。感染的发展与类固醇治疗持续时间有关，而与累积类固醇剂量无关。
皮质类固醇在严重 COVID-19 中显示出有益作用，但在轻度 COVID-19 患者中的早期皮质类固醇作用仍不清楚。皮质类固醇的抗炎作用可能通过降低重症 COVID-19 患者的死亡率产生积极影响。虽然地塞米松首先用于此目的，但发现标准剂量的甲基强的松龙同样有效。与地塞米松相比，标准剂量的甲基强的松龙与更大的 PaO/FiO 比值相关，尤其是在需要 MV 的严重组。高剂量脉冲类固醇剂量与死亡率密切相关，建议使用标准甲基强的松龙剂量。
