地塞米松对老年COVID-19患者谵妄患病率的影响：一项回顾性队列研究。
The effect of dexamethasone on the prevalence of delirium in older COVID-19 patients: a retrospective cohort study.
作者信息
van der Laan Chris, Goossens Kristel, Robben Sarah H M, Kappers Mariette H W
机构信息
Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
Department of Internal Medicine, Van Weel-Bethesda Hospital, Dirksland, The Netherlands.
出版信息
Eur Geriatr Med. 2025 Apr;16(2):665-672. doi: 10.1007/s41999-024-01033-7. Epub 2025 Feb 19.
PURPOSE
Corticosteroids decrease mortality in patients with COVID-19 in need of oxygen therapy. However, corticosteroids are known to increase the risk of delirium in older patients. We studied whether dexamethasone increased the risk of delirium in older patients hospitalized with COVID-19.
METHODS
Single centre, retrospective cohort study including patients ≥ 70 years hospitalized in a large teaching hospital with COVID-19 during the first (control group) and second wave (dexamethasone group, receiving dexamethasone) of the COVID-19 pandemic. Only patients on regular (non-ICU) wards were included. Delirium was defined as having a mean delirium observation screening (DOS)-score of ≥ 3 or having an altered mental state on day 3 of admission.
RESULTS
We included 233 patients. The mean age in the dexamethasone group was 78.83 years [SD 6.5] compared to 79.43 years [SD 6.3] in the control group. In the dexamethasone group (n = 114), less patients developed delirium compared to the control group (n = 119) on day 3 of admission (5.3% vs 15.1%; p = 0.01). The Odds ratio of dexamethasone use for delirium was 0.23 (95% CI 0.08-0.64).
CONCLUSION
In this study, dexamethasone did not increase the risk of delirium in older patients with COVID-19.
目的
皮质类固醇可降低需要吸氧治疗的新冠病毒病（COVID-19）患者的死亡率。然而，已知皮质类固醇会增加老年患者发生谵妄的风险。我们研究了地塞米松是否会增加因COVID-19住院的老年患者发生谵妄的风险。
方法
单中心回顾性队列研究，纳入在一家大型教学医院因COVID-19住院的≥70岁患者，分为第一波疫情期间住院的患者（对照组）和第二波疫情期间住院的患者（地塞米松组，接受地塞米松治疗）。仅纳入普通（非重症监护病房）病房的患者。谵妄定义为谵妄观察筛查（DOS）平均评分≥3或入院第3天精神状态改变。
结果
我们纳入了233例患者。地塞米松组的平均年龄为78.83岁[标准差6.5]，对照组为79.43岁[标准差6.3]。在入院第3天，地塞米松组（n = 114）发生谵妄的患者少于对照组（n = 119）（5.3%对15.1%；p = 0.01）。使用地塞米松导致谵妄的比值比为0.23（95%置信区间0.08 - 0.64）。
结论
在本研究中，地塞米松并未增加老年COVID-19患者发生谵妄的风险。
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