Kim Seohyun, Ryoo Jiwon, Cho Hyeong Jun, Kim Seok Chan, Park Sunghoon, Lee Su Hwan, Park Onyu, Kim Taehwa, Yeo Hye Ju, Jang Jin Ho, Cho Woo Hyun, Lee Jongmin
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Korean Med Sci. 2025 May 26;40(20):e82. doi: 10.3346/jkms.2025.40.e82.
The impact of steroid treatment on mortality outcomes in patients with coronavirus disease 2019 (COVID-19) has been widely demonstrated, while its effect on secondary infections, such as bloodstream infections (BSIs), is controversial. Recent studies have reported the survival benefits of using steroids for a standard duration compared to extended use, though their impact on the risk of BSIs remains debated. This study investigated whether extended steroid use is associated with the risk of BSIs and mortality in critically ill patients with COVID-19.
This national multicenter retrospective study conducted at 22 university-affiliated hospitals evaluated the effect of steroid treatment duration in hospitalized patients with COVID-19 treated with more than high-flow nasal cannula therapy. Patients were divided into two groups according to the duration of corticosteroid treatment: extended (> 10 days) and standard (≤ 10 days). Propensity score matching was performed by adjusting for covariates. Baseline characteristics and clinical outcomes were compared between the two groups.
Among 1,114 patients, 378 with a hospital length of stay (LOS) exceeding 10 days were included. Each group of the propensity score-matched cohort had 189 patients, with no significant differences in demographic characteristics between the two groups, except for the incidence of BSIs (extended group vs. standard group, 49.7% vs. 36.0%, = 0.043). After adjusting for confounding factors, extended use of steroids remained significantly associated with BSIs (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.25-4.04; = 0.007). The use of a mechanical ventilator, extracorporeal membrane oxygenation, continuous renal replacement therapy, and a longer hospital LOS were associated with BSIs. In-hospital mortality was associated with an older age, higher body mass index, higher sequential organ failure assessment score at admission, and the presence of a BSI (OR, 2.47; 95% CI, 1.50-4.05; < 0.001). Kaplan-Meier survival analysis demonstrated no significant difference in in-hospital mortality between the extended and standard groups.
Extended steroid therapy was significantly associated with a higher incidence of BSIs in critically ill patients with COVID-19.
2019冠状病毒病（COVID-19）患者中，类固醇治疗对死亡率的影响已得到广泛证实，但其对血流感染（BSIs）等继发感染的影响存在争议。近期研究报告称，与延长使用相比，标准疗程使用类固醇有生存获益，不过其对BSIs风险的影响仍存在争议。本研究调查了延长使用类固醇是否与COVID-19危重症患者的BSIs风险及死亡率相关。
这项在22家大学附属医院开展的全国多中心回顾性研究，评估了接受高流量鼻导管吸氧以上治疗的COVID-19住院患者中类固醇治疗时长的影响。根据皮质类固醇治疗时长将患者分为两组：延长组（>10天）和标准组（≤10天）。通过调整协变量进行倾向评分匹配。比较两组的基线特征和临床结局。
在1114例患者中，纳入了378例住院时间超过10天的患者。倾向评分匹配队列的每组各有189例患者，除BSIs发生率外（延长组vs.标准组，49.7% vs. 36.0%，P = 0.043），两组的人口统计学特征无显著差异。在调整混杂因素后，延长使用类固醇仍与BSIs显著相关（比值比[OR]，2.25；95%置信区间[CI]，1.25 - 4.04；P = 0.007）。使用机械通气、体外膜肺氧合、连续性肾脏替代治疗以及更长的住院时间与BSIs相关。院内死亡与年龄较大、体重指数较高、入院时序贯器官衰竭评估评分较高以及存在BSIs相关（OR，2.47；95% CI，1.50 - 4.05；P < 0.001）。Kaplan-Meier生存分析显示，延长组和标准组的院内死亡率无显著差异。
在COVID-19危重症患者中，延长类固醇治疗与BSIs的较高发生率显著相关。
