早期地塞米松对 COVID-19 结局的影响：使用倾向评分匹配的准实验研究。

Effect of early dexamethasone on outcomes of COVID-19: A quasi-experimental study using propensity score matching.

机构信息

Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.

出版信息

J Microbiol Immunol Infect. 2024 Jun;57(3):414-425. doi: 10.1016/j.jmii.2024.02.002. Epub 2024 Feb 17.

DOI:10.1016/j.jmii.2024.02.002

PMID:38402071

Abstract

BACKGROUND

The RECOVERY trial demonstrated that the use of dexamethasone is associated with a 36% lower 28-day mortality in hospitalized patients with COVID-19 on invasive mechanical ventilation. Nevertheless, the optimal timing to start dexamethasone remains uncertain.

METHODS

We conducted a quasi-experimental study at National Taiwan University Hospital (Taipei, Taiwan) using propensity score matching to simulate a randomized controlled trial to receive or not to receive early dexamethasone (6 mg/day) during the first 7 days following the onset of symptoms. Treatment was standard protocol-based, except for the timing to start dexamethasone, which was left to physicians' decision. The primary outcome is 28-day mortality. Secondary outcomes include secondary infection within 60 days and fulfilling the criteria of de-isolation within 20 days.

RESULTS

A total of 377 patients with COVID-19 were enrolled. Early dexamethasone did not decrease 28-day mortality in all patients (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.97-1.10) or in patients who required O2 for severe/critical disease at admission (aOR, 1.05; 95%CI, 0.94-1.18); but is associated with a 24% increase in superinfection in all patients (aOR, 1.24; 95% CI, 1.12-1.37) and a 23% increase in superinfection in patients of O2 for several/critical disease at admission (aOR, 1.23; 95% CI, 1.02-1.47). Moreover, early dexamethasone is associated with a 42% increase in likelihood of delayed clearance of SARS-CoV-2 virus (adjusted hazard ratio, 1.42; 95% CI, 1.01-1.98).

CONCLUSION

An early start of dexamethasone (within 7 days after the onset of symptoms) could be harmful to hospitalized patients with COVID-19.

摘要

背景

RECOVERY 试验表明，在接受有创机械通气的 COVID-19 住院患者中，使用地塞米松可降低 28 天死亡率 36%。然而，开始使用地塞米松的最佳时机仍不确定。

方法

我们在台湾大学医院（台北，中国台湾）进行了一项准实验研究，使用倾向评分匹配模拟随机对照试验，以模拟在症状出现后 7 天内接受或不接受早期地塞米松（6mg/天）。治疗是基于标准方案的，除了开始使用地塞米松的时间，这取决于医生的决定。主要结局是 28 天死亡率。次要结局包括 60 天内继发感染和 20 天内达到解除隔离标准。

结果

共纳入 377 例 COVID-19 患者。早期地塞米松并未降低所有患者（校正比值比[aOR]，1.03；95%置信区间[CI]，0.97-1.10）或入院时需要 O2 治疗严重/危重症患者（aOR，1.05；95%CI，0.94-1.18）的 28 天死亡率；但与所有患者继发感染增加 24%（aOR，1.24；95%CI，1.12-1.37）和入院时需要 O2 治疗严重/危重症患者继发感染增加 23%（aOR，1.23；95%CI，1.02-1.47）相关。此外，早期地塞米松与 SARS-CoV-2 病毒清除延迟的可能性增加 42%（校正风险比[aHR]，1.42；95%CI，1.01-1.98）相关。