Yalci A, Doğan E, Kapici M A, Demirkıran B Ç, Filiz M, Artuk C
Department of Infectious Diseases and Clinical Microbiology, University of Health Science, Gülhane Educational and Research Hospital, Ankara, Turkey.
Niger J Clin Pract. 2023 Sep;26(9):1348-1353. doi: 10.4103/njcp.njcp_110_23.
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic named coronavirus disease 2019 (COVID-19) that has become the greatest worldwide public health threat. Although different treatment recommendations are offered for COVID-19 infection, steroid treatment remains important.
We aimed to demonstrate the effect of pulse steroid therapy (PST) on inflammatory markers and patient outcomes in moderate/severe COVID-19 pneumonia.
We retrospectively analyzed the patients 18 years and older hospitalized in our hospital's COVID-19 clinics between April 1, 2020, to June 30, 2020, and July 1, 2021, to November 30, 2021. Patients in the moderate/severe COVID-19 pneumonia category, according to the World Health Organization COVID-19 guidelines, were included in the study. The demographic characteristics of the patients, treatments, inflammatory markers, and patient outcomes (need for intensive care, length of hospital stay, high-flow nasal oxygen (HFNO) requirement, mechanical ventilation (MV), and mortality rates) were recorded and analyzed.
Patients who received PST had more advanced age (P < 0.01), more comorbidities (P < 0.001), and more HFNO need (P < 001) compared with the patients who did not receive PST. There was no statistically significant difference between clinical outcomes: the need for intensive care, length of hospital stay, need for MV, and mortality rates (P = 0.54, P = 0.3, P = 0.14, and P = 0.09, respectively). When we evaluated the unvaccinated patients, there was a statistically significant difference in the MV need and mortality rates between those who received PST and those who did not (P = 0.017, P = 0.014, respectively).
It was observed that PST provided similar mortality, ICU, and MV requirements in patients with older age and comorbidities. Lower MV requirements and mortality were observed in the unvaccinated group receiving PST compared with the unvaccinated group not receiving steroids. PST is still promising in COVID-19 infection, and more studies are needed for standard doses and applications.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的出现引发了一场名为2019冠状病毒病（COVID-19）的大流行，已成为全球最大的公共卫生威胁。尽管针对COVID-19感染提供了不同的治疗建议，但类固醇治疗仍然很重要。
我们旨在证明脉冲类固醇疗法（PST）对中度/重度COVID-19肺炎患者炎症标志物及预后的影响。
我们回顾性分析了2020年4月1日至2020年6月30日以及2021年7月1日至2021年11月30日期间在我院COVID-19诊所住院的18岁及以上患者。根据世界卫生组织COVID-19指南，将中度/重度COVID-19肺炎患者纳入研究。记录并分析患者的人口统计学特征、治疗方法、炎症标志物及患者预后（重症监护需求、住院时间、高流量鼻导管吸氧（HFNO）需求、机械通气（MV）及死亡率）。
与未接受PST的患者相比接受PST的患者年龄更大（P<0.01）、合并症更多（P<0.001）、HFNO需求更多（P<0.01）。临床结局方面无统计学显著差异：重症监护需求、住院时间、MV需求及死亡率（分别为P=0.54、P=0.3、P=0.14及P=0.09）。当我们评估未接种疫苗的患者时，接受PST的患者与未接受PST的患者在MV需求及死亡率方面存在统计学显著差异（分别为P=0.017、P=0.0）。
观察到PST在老年及合并症患者中提供了相似的死亡率、重症监护及MV需求。与未接受类固醇治疗的未接种疫苗组相比，接受PST的未接种疫苗组MV需求及死亡率更低。PST在COVID-19感染中仍有前景，对于标准剂量及应用还需要更多研究。
