Mowafy Hatem Hossam, Elkhwaas Mohamed Tarek, AlGengeehy Shereen Moustafa, Zaghla Hanan Elsayed, Abdelfattah Marwa Elsayed
Department of Critical Care Medicine, Kasr AL Ainy Hospital, Cairo, Egypt.
Department of Critical Care and Emergency Medicine, Helwan University Hospital, Badr City, Egypt.
Int J Crit Illn Inj Sci. 2024 Apr-Jun;14(2):86-93. doi: 10.4103/ijciis.ijciis_52_23. Epub 2024 Jun 21.
Many protocols for the treatment of coronavirus disease 2019 (COVID-19) have been published. In addition to an abundance of studies and meta-analyses on the treatment of COVID-19, different medications used in the intensive care unit will have a significant impact on mortality. The study attempted to highlight, compare, and quantify the impact on outcomes.
Data were collected from subjects' files, encompassing all physiological parameters, hematological profiles, and available laboratory results. In addition, all treatment modalities administered to the subjects were documented in medical files. Survival analysis was conducted using Kaplan-Meier curves and Cox proportional hazards.
The study included 120 subjects with confirmed COVID-19. Subjects treated with systemic corticosteroids (hazard Ratio [HR 0.45, 95% Confidence Interval [CI] 0.01-1.32; = 0.01) and tocilizumab (HR 0.98, 95% CI 0.49-1.98; = 0.05) exhibited lower mortality, while those treated with remdesivir (HR 1.13, 95% CI 0.53-2.43; = 0.05) showed increased mortality. In patients with COVID-19, improved mortality was observed with early rather than late treatment with noninvasive mechanical ventilation (NIV) (HR 0.01 vs. 1.72, = 0.05) and tocilizumab (HR 0.45 vs. 1.50, = 0.05).
The early use of NIV is associated with decreased mortality compared to late use. Corticosteroids demonstrate a mortality-reducing effect. In addition, early administration of tocilizumab is associated with decreased mortality compared to late use.
已发布了许多治疗2019冠状病毒病（COVID-19）的方案。除了大量关于COVID-19治疗的研究和荟萃分析外，重症监护病房中使用的不同药物将对死亡率产生重大影响。该研究试图突出、比较并量化对结局的影响。
从受试者档案中收集数据，包括所有生理参数、血液学指标和可用的实验室结果。此外，受试者接受的所有治疗方式都记录在医疗档案中。使用Kaplan-Meier曲线和Cox比例风险模型进行生存分析。
该研究纳入了120例确诊的COVID-19患者。接受全身皮质类固醇治疗的受试者（风险比[HR]0.45，95%置信区间[CI]0.01-1.32；P = 0.01）和托珠单抗治疗的受试者（HR 0.98，95%CI 0.49-1.98；P = 0.05）死亡率较低，而接受瑞德西韦治疗的受试者（HR 1.13，95%CI 0.53-2.43；P = 0.05）死亡率增加。在COVID-19患者中，与延迟治疗相比，早期使用无创机械通气（NIV）（HR 0.01对1.72，P = 0.05）和托珠单抗（HR 0.45对1.50，P = 0.05）可改善死亡率。
与延迟使用相比，早期使用NIV与死亡率降低相关。皮质类固醇显示出降低死亡率的作用。此外，与延迟使用相比，早期给予托珠单抗与死亡率降低相关。
