Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
Department of General Practice, People's Hospital of Chongqing Heuchan, Chongqing, 401520, People's Republic of China.
Sci Rep. 2024 Oct 16;14(1):24317. doi: 10.1038/s41598-024-75926-9.
Corticosteroids have always been recommended for severe cases of COVID-19. However, the efficacy of treatment with corticosteroids for COVID-19 during the SARS-CoV-2 omicron outbreak in China has not been reported. Clinical data from 406 patients hospitalized for severe/critical COVID-19 from December 2022 to January 2023 at six hospitals in Chongqing were retrospectively analyzed. The primary outcome was all-cause mortality at 28 days in the groups with and without corticosteroids treatment after propensity score matching (PSM). Secondary outcomes were to compare in-hospital mortality and length of survival time with corticosteroids and those without corticosteroids. This study included 406 patients with severe or critical COVID-19, divided into the corticosteroids group (231, 56.9%) and non-corticosteroids group (175, 43.1%). After PSM, the use of corticosteroids did not reduce all-cause mortality at 28 days (42.5% vs. 39.1%). Univariate analysis showed that corticosteroids were not associated with improved all-cause mortality at 28 days [hazard ratio (HR), 1.019; 95% confidence interval (CI), 0.639-1.623; p = 0.938]. Multivariate analysis showed similar results (HR, 1.047; 95% CI, 0.633-1.732; p = 0.858). Among non-survivors, the survival time was significantly larger in those who received corticosteroids compared with the non-corticosteroid users [median 13 (IQR 6.5-15.5) vs. 6 (4-11.25), p = 0.007]. The use of systemic corticosteroids in severe/critical COVID-19 may provide certain potential survival benefits but does not improve prognosis.
皮质类固醇一直被推荐用于治疗 COVID-19 重症病例。然而，在中国 SARS-CoV-2 奥密克戎爆发期间，皮质类固醇治疗 COVID-19 的疗效尚未有报道。回顾性分析了 2022 年 12 月至 2023 年 1 月重庆六家医院收治的 406 例重症/危重症 COVID-19 住院患者的临床数据。主要结局是倾向评分匹配（PSM）后皮质类固醇治疗组和无皮质类固醇治疗组 28 天的全因死亡率。次要结局是比较皮质类固醇组和无皮质类固醇组的住院死亡率和生存时间。这项研究纳入了 406 例重症或危重症 COVID-19 患者，分为皮质类固醇组（231 例，56.9%）和非皮质类固醇组（175 例，43.1%）。PSM 后，皮质类固醇的使用并未降低 28 天的全因死亡率（42.5% vs. 39.1%）。单因素分析显示，皮质类固醇与 28 天全因死亡率的改善无关[风险比（HR），1.019；95%置信区间（CI），0.639-1.623；p=0.938]。多因素分析也得到了相似的结果（HR，1.047；95%CI，0.633-1.732；p=0.858）。在非幸存者中，接受皮质类固醇治疗的患者的生存时间明显长于未使用皮质类固醇的患者[中位数 13（IQR 6.5-15.5）vs. 6（4-11.25），p=0.007]。在重症/危重症 COVID-19 中使用全身皮质类固醇可能提供一定的潜在生存获益，但不能改善预后。
