Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan.
Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan.
Int J Immunopathol Pharmacol. 2023 Jan-Dec;37:3946320231216314. doi: 10.1177/03946320231216314.
: Dexamethasone's (DEXA) beneficial effect on survival when administered to critically ill patients with coronavirus disease 2019 (COVID-19) has been documented in randomized trials and meta-analyses. Here, we conducted this study to clarify the association between time from COVID-19 onset to steroid initiation and mortality and to examine the factors underlying these results.: This was a multicenter, retrospective, observational study of patients enrolled in the Japanese COVID-19 Registry from January 1, 2020, to April 30, 2021. Demographic and clinical factors were extracted from patient records. Patients diagnosed with COVID-19 using polymerase chain reaction, loop-mediated isothermal amplification, or antigen tests were included. Patients aged <18 years, pregnant, with a history of chronic obstructive pulmonary disease or steroid or immunosuppressive drug use, transferred to another hospital, or with an unknown symptom onset were excluded.: The analysis included 3692 patients (men, 64.1%; median age, 68 years). Unadjusted comparisons of mortality groups showed significant differences in demographic and clinical characteristics; patients with early dexamethasone initiation had more risk factors for severe disease and significantly higher mortality than did patients with delayed initiation (13.3% vs 7.9%, < .001). No significant differences were found in intubation rates or duration, length of hospitalization, or time from intubation to death. Multivariate analyses showed significant differences from symptom onset to steroid administration, with an adjusted odds ratio of 0.7 ( = .05) for patients who received steroids for ≥8 days. Early steroid administration to COVID-19 patients was associated with increased mortality, suggesting a subset with early severe disease and high mortality and/or adverse effects of early steroid administration.
地塞米松（DEXA）在 2019 年冠状病毒病（COVID-19）危重症患者中的生存获益已在随机试验和荟萃分析中得到证实。在这里，我们进行了这项研究，以阐明 COVID-19 发病至类固醇开始的时间与死亡率之间的关系，并探讨这些结果的基础因素。
这是一项多中心、回顾性、观察性研究，纳入了 2020 年 1 月 1 日至 2021 年 4 月 30 日期间参加日本 COVID-19 登记处的患者。从患者记录中提取人口统计学和临床因素。使用聚合酶链反应、环介导等温扩增或抗原检测诊断为 COVID-19 的患者被纳入研究。排除年龄<18 岁、孕妇、慢性阻塞性肺疾病或类固醇或免疫抑制剂使用史、转院或症状发作不明的患者。
分析纳入了 3692 名患者（男性，64.1%；中位年龄，68 岁）。未调整死亡率组的比较显示，人口统计学和临床特征存在显著差异；早期使用地塞米松的患者有更多严重疾病的危险因素，死亡率明显高于延迟使用的患者（13.3%比 7.9%，<.001）。插管率或持续时间、住院时间或从插管到死亡的时间无显著差异。多变量分析显示，从症状发作到类固醇给药有显著差异，接受类固醇治疗≥8 天的患者调整后的优势比为 0.7（=0.05）。COVID-19 患者早期使用类固醇与死亡率增加相关，这表明存在早期严重疾病和高死亡率以及/或早期类固醇给药不良影响的亚组。
