Healthcare Practitioner at the Department of Internal Medicine, Aga University, Nairobi, Kenya.
Statistician at the Department of Internal Medicine and Brain and Mind Institute, Aga Khan University, Nairobi, Kenya.
PLoS One. 2024 Aug 20;19(8):e0307265. doi: 10.1371/journal.pone.0307265. eCollection 2024.
Among therapeutic options for severe and critical COVID- 19 infection, dexamethasone six milligrams once daily for ten days has demonstrated mortality benefit and is guideline recommended at this dose. In practice, variable doses of steroids have been used, especially in critical care settings. Our study aimed to determine the pattern of steroid dosing and outcomes in terms of critical care mortality, occurrence of dysglycaemias, and occurrence of superadded infections in patients with critical COVID-19.
A retrospective cohort study was carried out on all eligible patients admitted to the Aga Khan University Hospital, Nairobi, with critical COVID-19 between 1st March 2020 and 31st December 2021. The intervention of interest was corticosteroids quantified as the average daily dose in milligrams of dexamethasone. A steroid dose of six milligrams once a day was compared to high dose steroid dosing, which was defined as any dose greater than this. The primary outcome measure was ICU mortality and secondary outcomes included occurrence of dysglycaemias, superadded infections and duration of critical care admission.
The study included 288 patients. The median age was 61.2 years (IQR: 49.7, 72.5), with 71.2% of patients being male. The most common comorbidities were diabetes mellitus (60.7%), hypertension (58%), and heart disease (12.2%). The average oxygen saturation and C-reactive protein at admission were 82% [IQR: 70.0-89.0]and 113.0 [IQR: 54.0-186.0], respectively. Fifty-eight percent of patients received a standard dose (6mg) of steroids. The mortality rate was higher in the high-dose group compared to the standard-dose group; however, the difference was not statistically significant (47.9% vs 43.7% p = 0.549). The two most common steroid associated adverse effects were uncomplicated hyperglycemia (62.2%) and superimposed bacterial pneumonia (20.1%). The high-dose group had a higher incidence of uncomplicated hyperglycemia compared to the standard-dose group (63.6% vs 61.1%). However, the incidence of diabetic ketoacidosis was lower in the high dose group (0.6% vs 6.6%). Oxygen saturation at admission was associated with survival where it was lower among non-survivor patients with critical COVID-19.
The study found that high-dose steroids in the treatment of critically ill patients with COVID-19 pneumonia did not confer any mortality benefit and were associated with an increased risk of dysglycemia and superimposed infections.
在治疗严重和危急的 COVID-19 感染的治疗方法中，地塞米松每天 6 毫克，持续十天，已显示出对死亡率的益处，且指南推荐该剂量。实际上，已使用了不同剂量的类固醇，尤其是在重症监护环境中。我们的研究旨在确定在重症 COVID-19 患者中，类固醇剂量模式以及重症监护死亡率、发生血糖异常和发生继发感染的结果。
对 2020 年 3 月 1 日至 2021 年 12 月 31 日期间在肯尼亚内罗毕 Aga Khan 大学医院因重症 COVID-19 住院的所有符合条件的患者进行了回顾性队列研究。感兴趣的干预措施是皮质类固醇，其量化为地塞米松的平均每日剂量（毫克）。将 6 毫克/天的单次剂量类固醇与高剂量类固醇治疗进行比较，高剂量类固醇定义为任何大于该剂量的剂量。主要观察终点是 ICU 死亡率，次要观察终点包括血糖异常、继发感染和重症监护住院时间。
该研究纳入了 288 名患者。中位年龄为 61.2 岁（IQR：49.7，72.5），71.2%的患者为男性。最常见的合并症为糖尿病（60.7%）、高血压（58%）和心脏病（12.2%）。入院时的平均血氧饱和度和 C 反应蛋白分别为 82%[IQR：70.0-89.0]和 113.0[IQR：54.0-186.0]。58%的患者接受了标准剂量（6mg）的类固醇治疗。与标准剂量组相比，高剂量组的死亡率更高；然而，差异无统计学意义（47.9% vs 43.7%，p = 0.549）。类固醇相关的两种最常见不良事件是单纯性高血糖（62.2%）和继发细菌性肺炎（20.1%）。与标准剂量组相比，高剂量组单纯性高血糖的发生率更高（63.6% vs 61.1%）。然而，高剂量组糖尿病酮症酸中毒的发生率较低（0.6% vs 6.6%）。入院时的血氧饱和度与生存率相关，在患有重症 COVID-19 的非幸存者中，该值较低。
研究发现，在治疗 COVID-19 肺炎危重症患者时，高剂量类固醇并未带来任何死亡率益处，反而增加了血糖异常和继发感染的风险。
