Roël Mari, Schandl Anna, Jonmarker Sandra, Hedman Anders, Vogel Gisela, Joelsson-Alm Eva, Cronhjort Maria, Darlington Pernilla
Department of Internal Medicine, Södersjukhuset, Stockholm, SE-118 83, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, SE-118 83, Sweden.
BMC Pulm Med. 2025 Apr 26;25(1):201. doi: 10.1186/s12890-025-03659-0.
Early in the pandemic, corticosteroids became standard treatment for patients with critical COVID-19 infections. This study aimed to investigate the possible long-term pulmonary consequences after corticosteroid treatment in patients with critical COVID-19 requiring ventilatory support.
This observational single-center cohort study included patients treated for critical COVID-19 requiring ventilatory support between March 1, 2020, and August 1, 2021, with a 6-month follow-up after discharge from the intensive care unit. Corticosteroid treatment was defined according to the RECOVERY trial (6 mg dexamethasone daily or equivalent dose of another corticosteroid, initiated within eight days of hospital admittance and continued for at least one day) Pulmonary function was assessed by diffusion capacity for carbon monoxide. Health-related quality of life was measured with the questionnaire RAND-36. General linear regression was used to present mean score differences with 95% confidence intervals.
Among the 456 (69%) critically ill COVID-19 patients who survived at least 90 days after ICU discharge, 286 (63%) attended the follow-up six months later. The groups were balanced regarding invasive ventilation; 47% received invasive ventilation in both groups. Corticosteroid treatment was associated with a lower diffusion capacity for carbon monoxide (MSD - 8.3, 95% CI: -14.2 to -2.4) 6 months after ICU discharge (change > 10% were regarded as clinically significant). There were no differences in health-related quality of life between the groups.
Corticosteroids might negatively impact pulmonary function after critical COVID-19. The decrease did not seem to influence health-related quality of life. Future studies are needed to confirm the results.
在疫情早期，皮质类固醇成为重症新型冠状病毒肺炎（COVID-19）感染患者的标准治疗方法。本研究旨在调查需要通气支持的重症COVID-19患者接受皮质类固醇治疗后可能出现的长期肺部后果。
这项观察性单中心队列研究纳入了2020年3月1日至2021年8月1日期间因重症COVID-19需要通气支持而接受治疗的患者，并在重症监护病房出院后进行了6个月的随访。皮质类固醇治疗根据RECOVERY试验进行定义（每日6毫克地塞米松或等量剂量的另一种皮质类固醇，在入院8天内开始并持续至少1天）。通过一氧化碳弥散量评估肺功能。使用RAND-36问卷测量健康相关生活质量。采用一般线性回归呈现平均得分差异及95%置信区间。
在456例（69%）重症COVID-19患者中，有286例（63%）在重症监护病房出院后至少存活90天，并在6个月后参加了随访。两组在有创通气方面情况均衡；两组中47%的患者接受了有创通气。在重症监护病房出院6个月后，皮质类固醇治疗与较低的一氧化碳弥散量相关（平均得分差异-8.3，95%置信区间：-14.2至-2.4）（变化>10%被视为具有临床意义）。两组在健康相关生活质量方面没有差异。
皮质类固醇可能对重症COVID-19后的肺功能产生负面影响。这种下降似乎并未影响健康相关生活质量。需要进一步的研究来证实这些结果。
