新冠病毒病全身性皮质类固醇治疗的1年健康结局：一项纵向队列研究
1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study.
作者信息
Leavy Olivia C, Russell Richard J, Harrison Ewen M, Lone Nazir I, Kerr Steven, Docherty Annemarie B, Sheikh Aziz, Richardson Matthew, Elneima Omer, Greening Neil J, Harris Victoria Claire, Houchen-Wolloff Linzy, McAuley Hamish J C, Saunders Ruth M, Sereno Marco, Shikotra Aarti, Singapuri Amisha, Aul Raminder, Beirne Paul, Bolton Charlotte E, Brown Jeremy S, Choudhury Gourab, Diar Bakerly Nawar, Easom Nicholas, Echevarria Carlos, Fuld Jonathan, Hart Nick, Hurst John R, Jones Mark, Parekh Dhruv, Pfeffer Paul, Rahman Najib M, Rowland-Jones Sarah, Shah Ajay M, Wootton Dan G, Jolley Caroline, Thompson A A Roger, Chalder Trudie, Davies Melanie J, De Soyza Anthony, Geddes John R, Greenhalf William, Heller Simon, Howard Luke, Jacob Joseph, Jenkins R Gisli, Lord Janet M, Man Will D-C, McCann Gerry P, Neubauer Stefan, Openshaw Peter J M, Porter Joanna, Rowland Matthew J, Scott Janet T, Semple Malcolm G, Singh Sally J, Thomas David, Toshner Mark, Lewis Keir, Heaney Liam G, Briggs Andrew, Zheng Bang, Thorpe Mathew, Quint Jennifer K, Chalmers James D, Ho Ling-Pei, Horsley Alex, Marks Michael, Poinasamy Krisnah, Raman Betty, Wain Louise V, Brightling Christopher E, Evans Rachael A
机构信息
Department of Population Health Sciences, University of Leicester, Leicester, UK.
The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
出版信息
ERJ Open Res. 2024 Sep 30;10(5). doi: 10.1183/23120541.00474-2024. eCollection 2024 Sep.
BACKGROUND
In patients with coronavirus disease 2019 (COVID-19) requiring supplemental oxygen, dexamethasone reduces acute severity and improves survival, but longer-term effects are unknown. We hypothesised that systemic corticosteroid administration during acute COVID-19 would be associated with improved health-related quality of life (HRQoL) 1 year after discharge.
METHODS
Adults admitted to hospital between February 2020 and March 2021 for COVID-19 and meeting current guideline recommendations for dexamethasone treatment were included using two prospective UK cohort studies (Post-hospitalisation COVID-19 and the International Severe Acute Respiratory and emerging Infection Consortium). HRQoL, assessed by the EuroQol-Five Dimensions-Five Levels utility index (EQ-5D-5L UI), pre-hospital and 1 year after discharge were compared between those receiving corticosteroids or not after propensity weighting for treatment. Secondary outcomes included patient-reported recovery, physical and mental health status, and measures of organ impairment. Sensitivity analyses were undertaken to account for survival and selection bias.
FINDINGS
Of the 1888 participants included in the primary analysis, 1149 received corticosteroids. There was no between-group difference in EQ-5D-5L UI at 1 year (mean difference 0.004, 95% CI -0.026-0.034). A similar reduction in EQ-5D-5L UI was seen at 1 year between corticosteroid exposed and nonexposed groups (mean±sd change -0.12±0.22 -0.11±0.22). Overall, there were no differences in secondary outcome measures. After sensitivity analyses modelled using a cohort of 109 318 patients admitted to hospital with COVID-19, EQ-5D-5L UI at 1 year remained similar between the two groups.
INTERPRETATION
Systemic corticosteroids for acute COVID-19 have no impact on the large reduction in HRQoL 1 year after hospital discharge. Treatments to address the persistent reduction in HRQoL are urgently needed.
背景
在需要补充氧气的2019冠状病毒病（COVID-19）患者中，地塞米松可降低急性严重程度并提高生存率，但长期影响尚不清楚。我们假设在急性COVID-19期间全身性使用皮质类固醇与出院1年后健康相关生活质量（HRQoL）的改善有关。
方法
采用两项前瞻性英国队列研究（住院后COVID-19和国际严重急性呼吸及新发感染联盟）纳入2020年2月至2021年3月因COVID-19住院且符合当前地塞米松治疗指南推荐的成年人。在对治疗进行倾向加权后，比较接受或未接受皮质类固醇治疗的患者在院前和出院1年后通过欧洲五维健康量表-五级效用指数（EQ-5D-5L UI）评估的HRQoL。次要结局包括患者报告的康复情况、身心健康状况以及器官损害指标。进行敏感性分析以考虑生存和选择偏倚。
结果
纳入主要分析的1888名参与者中，1149人接受了皮质类固醇治疗。1年时两组间EQ-5D-5L UI无差异（平均差异0.004，95%CI -0.026至0.034）。在暴露于皮质类固醇和未暴露组之间，1年时EQ-5D-5L UI也有类似程度的降低（平均±标准差变化 -0.12±0.22 -0.11±0.22）。总体而言，次要结局指标无差异。在使用109318名COVID-19住院患者队列进行建模的敏感性分析后，两组间1年时的EQ-5D-5L UI仍相似。
解读
急性COVID-19全身性使用皮质类固醇对出院1年后HRQoL的大幅降低没有影响。迫切需要采取措施解决HRQoL持续下降的问题。
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