Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis

被引：39

作者：

Wu, Chaomin ^{[1
,2
]}

Hou, Dongni ^{[2
]}

Du, Chunling ^{[1
]}

Cai, Yanping ^{[3
]}

Zheng, Junhua ^{[4
]}

Xu, Jie ^{[5
]}

Chen, Xiaoyan ^{[2
]}

Chen, Cuicui ^{[2
]}

Hu, Xianglin ^{[2
]}

Zhang, Yuye ^{[2
]}

Song, Juan ^{[2
]}

Wang, Lu ^{[2
]}

Chao, Yen-cheng ^{[2
]}

Feng, Yun ^{[6
]}

Xiong, Weining ^{[7
]}

Chen, Dechang ^{[8
]}

Zhong, Ming ^{[9
]}

Hu, Jie ^{[2
]}

Jiang, Jinjun ^{[2
]}

Bai, Chunxue ^{[2
]}

Zhou, Xin ^{[10
]}

Xu, Jinfu ^{[11
]}

Song, Yuanlin ^{[1
,2
,12
,13
,14
]}

Gong, Fengyun ^{[3
]}

机构：

[1] Fudan Univ, Zhongshan Hosp, QingPu Branch, Dept Pulm & Crit Care Med, Shanghai, Peoples R China

[2] Fudan Univ, Zhongshan Hosp, Dept Pulm & Crit Care Med, Shanghai, Peoples R China

[3] Wuhan Jin Yin Tan Hosp, Infect Div, Wuhan, Peoples R China

[4] Shanghai Jiao Tong Univ, Sch Med, Shanghai Gen Hosp, Dept Urol, Shanghai, Peoples R China

[5] Fengxian Guhua Hosp, Dept Infect Dis, Shanghai, Peoples R China

[6] Shanghai Jiao Tong Univ, Shanghai Peoples Hosp 1, Sch Med, Dept Gastroenterol, Shanghai, Peoples R China

[7] Shanghai Jiao Tong Univ, Sch Med, Shanghai Peoples Hosp 9, Dept Resp & Crit Care Med, Shanghai, Peoples R China

[8] Shanghai Jiao Tong Univ, Sch Med, Ruijin Hosp, Dept Crit Care Med, Shanghai, Peoples R China

[9] Fudan Univ, Zhongshan Hosp, Dept Crit Care Med, Shanghai, Peoples R China

[10] Shanghai Jiao Tong Univ, Sch Med, Shanghai Peoples Hosp 1, Dept Pulm Med, Shanghai, Peoples R China

[11] Shanghai Pulm Hosp, Dept Resp & Crit Care Med, Shanghai, Peoples R China

[12] Shanghai Resp Res Inst, Shanghai, Peoples R China

[13] Fudan Univ, Natl Clin Res Ctr Aging & Med, Huashan Hosp, Shanghai, Peoples R China

[14] Fudan Univ, Jinshan Hosp, Shanghai, Peoples R China

来源：

CRITICAL CARE | 2020年 / 24卷 / 01期

基金：

中国国家自然科学基金;

关键词：

Corticosteroids; Coronavirus disease 2019; Severe acute respiratory syndrome coronavirus 2; Mortality; Propensity score; Methylprednisolone; CRITICALLY-ILL PATIENTS; ARDS; BIAS;

D O I：

10.1186/s13054-020-03340-4

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background The impact of corticosteroid therapy on outcomes of patients with coronavirus disease 2019 (COVID-19) is highly controversial. We aimed to compare the risk of death between COVID-19-related ARDS patients with corticosteroid treatment and those without. Methods In this single-center retrospective observational study, patients with ARDS caused by COVID-19 between January 20, 2020, and February 24, 2020, were enrolled. The primary outcome was 60-day in-hospital death. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality. Results A total of 382 patients [60.7 +/- 14.1 years old (mean +/- SD), 61.3% males] were analyzed. The median of sequential organ failure assessment (SOFA) score was 2.0 (IQR 2.0-3.0). Of these cases, 94 (24.6%) patients had invasive mechanical ventilation. The number of patients received systemic corticosteroids was 226 (59.2%), and 156 (40.8%) received standard treatment. The maximum dose of corticosteroids was 80.0 (IQR 40.0-80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0-12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death within 60 days after adjusting for age, sex, SOFA score at hospital admission, propensity score of corticosteroid treatment, comorbidities, antiviral treatment, and respiratory supports (HR 0.42; 95% CI 0.21, 0.85; p = 0.0160). Corticosteroids were not associated with delayed viral RNA clearance in our cohort. Conclusion In this clinical practice setting, low-dose corticosteroid treatment was associated with reduced risk of in-hospital death within 60 days in COVID-19 patients who developed ARDS.

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页数：10

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