Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
J Microbiol Immunol Infect. 2023 Dec;56(6):1207-1213. doi: 10.1016/j.jmii.2023.08.008. Epub 2023 Sep 1.
Coronavirus disease-2019 (COVID-19) remains a global public health concern, and remdesivir plus dexamethasone combination therapy is suggested for patients with severe disease. However, the factors associated with poor outcomes in these patients remain unclear. We identified the factors associated with poor outcomes in Taiwanese patients with severe COVID-19 treated with remdesivir plus dexamethasone.
Adults with severe COVID-19 (oxygen saturation <94% on room air or requiring supplemental oxygen) treated with remdesivir and dexamethasone were identified between 1 May and 31 July 2021. The main outcomes were 14-day non-recovery, 28-day mortality, and progression to respiratory failure requiring invasive mechanical ventilation or death in initially non-ventilated patients. The prognostic factors associated with poor outcomes were analyzed by multivariate logistic regression and Cox regression.
Of the 110 patients treated with remdesivir and dexamethasone, 57 (51.8%) recovered within 14 days and 6 (5.5%) died within 28 days. Of the 89 initially non-ventilated patients, 12 (13.5%) progressed to respiratory failure or death. Charlson Comorbidity Index, SOFA score, and admission to remdesivir treatment interval were associated with 14-day non-recovery. C-reactive protein level was associated with 28-day mortality. Pneumonia Severity Index and admission to remdesivir treatment interval were associated with progression to respiratory failure requiring invasive mechanical ventilation or death in initially non-ventilated patients.
High disease severity on admission and delayed initiation of remdesivir therapy were associated with poor outcomes in COVID-19 patients treated with remdesivir and dexamethasone.
新型冠状病毒病-2019（COVID-19）仍然是一个全球公共卫生关注点，对于重症患者，建议采用瑞德西韦联合地塞米松的联合治疗方案。然而，这些患者不良结局的相关因素尚不清楚。本研究旨在明确接受瑞德西韦联合地塞米松治疗的台湾 COVID-19 重症患者不良结局的相关因素。
本研究纳入了 2021 年 5 月 1 日至 7 月 31 日期间接受瑞德西韦和地塞米松治疗的 COVID-19 重症患者（室内空气下血氧饱和度<94%或需要补充氧气）。主要结局为 14 天未恢复、28 天死亡率以及初始未机械通气患者进展为需要有创机械通气或死亡的呼吸衰竭。通过多变量逻辑回归和 Cox 回归分析与不良结局相关的预后因素。
在接受瑞德西韦和地塞米松治疗的 110 例患者中，57 例（51.8%）在 14 天内恢复，6 例（5.5%）在 28 天内死亡。在 89 例初始未机械通气的患者中，12 例（13.5%）进展为呼吸衰竭或死亡。Charlson 合并症指数、SOFA 评分和瑞德西韦治疗开始时间与 14 天未恢复相关。C 反应蛋白水平与 28 天死亡率相关。肺炎严重指数和瑞德西韦治疗开始时间与初始未机械通气患者进展为需要有创机械通气或死亡的呼吸衰竭相关。
入院时疾病严重程度高和瑞德西韦治疗开始时间延迟与 COVID-19 患者接受瑞德西韦和地塞米松治疗的不良结局相关。
