Corticosteroids for hospitalized patients with mild to critically-ill COVID-19: a multicenter, retrospective, propensity score-matched study

被引：17

作者：

Ikeda, Satoshi ^{[1
]}

Misumi, Toshihiro ^{[2
]}

Izumi, Shinyu ^{[3
]}

Sakamoto, Keita ^{[3
]}

Nishimura, Naoki ^{[4
]}

Ro, Shosei ^{[4
]}

Fukunaga, Koichi ^{[5
]}

Okamori, Satoshi ^{[5
]}

Tachikawa, Natsuo ^{[6
]}

Miyata, Nobuyuki ^{[6
]}

Shinkai, Masaharu ^{[7
]}

Shinoda, Masahiro ^{[7
]}

Miyazaki, Yasunari ^{[8
]}

Iijima, Yuki ^{[8
]}

Izumo, Takehiro ^{[9
]}

Inomata, Minoru ^{[9
]}

Okamoto, Masaki ^{[10
]}

Yamaguchi, Tomoyoshi ^{[11
]}

Iwabuchi, Keisuke ^{[12
]}

Masuda, Makoto ^{[13
]}

Takoi, Hiroyuki ^{[14
]}

Oyamada, Yoshitaka ^{[15
]}

Fujitani, Shigeki ^{[16
]}

Mineshita, Masamichi ^{[17
]}

Ishii, Haruyuki ^{[18
]}

Nakagawa, Atsushi ^{[19
]}

Yamaguchi, Nobuhiro ^{[20
]}

Hibino, Makoto ^{[21
]}

Tsushima, Kenji ^{[22
]}

Nagai, Tatsuya ^{[23
]}

Ishikawa, Satoru ^{[24
]}

Ishikawa, Nobuhisa ^{[25
]}

Kondoh, Yasuhiro ^{[26
]}

Yamazaki, Yoshitaka ^{[27
]}

Gocho, Kyoko ^{[28
]}

Nishizawa, Tomotaka ^{[29
]}

Tsuzuku, Akifumi ^{[30
]}

Yagi, Kazuma ^{[31
]}

Shindo, Yuichiro ^{[32
]}

Takeda, Yuriko ^{[2
]}

Yamanaka, Takeharu ^{[2
]}

Ogura, Takashi ^{[1
]}

机构：

[1] Kanagawa Cardiovasc & Resp Ctr, Dept Resp Med, Kanazawa Ku, 6-16-1 Tomioka Higashi, Yokohama, Kanagawa 2360051, Japan

[2] Yokohama City Univ, Dept Biostat, Sch Med, Kanazawa Ku, 3-9 Fukuura, Yokohama, Kanagawa 2360004, Japan

[3] Natl Ctr Global Hlth & Med, Dept Resp Med, Shinjuku Ku, 21-1 Toyama, Tokyo 1628655, Japan

[4] St Lukes Int Hosp, Thorac Ctr, Dept Pulm Med, Chuo Ku, 9-1 Akashi Cho, Tokyo 1048560, Japan

[5] Keio Univ, Dept Med, Div Pulm Med, Sch Med,Shinjuku Ku, 35 Shinanomachi, Tokyo 1608582, Japan

[6] Yokohama Municipal Citizens Hosp, Dept Infect Dis, Kanagawa Ku, 1 Mitsuzawanishimachi, Yokohama, Kanagawa 2210855, Japan

[7] Tokyo Shinagawa Hosp, Dept Internal Med, Shinagawa Ku, 6-3-22 Higashioi, Tokyo 1408522, Japan

[8] Tokyo Med & Dent Univ, Dept Resp Med, Bunkyo Ku, 1-5-45 Yushima, Tokyo 1138510, Japan

[9] Japanese Red Cross Med Ctr, Dept Resp Med, Shibuya Ku, 4-1-22 Hiroo, Tokyo 1508935, Japan

[10] Natl Hosp Org Kyushu Med Ctr, Clin Res Inst, Dept Respirol, Chuo Ku, 1-8-1 Chigyohama, Fukuoka 8100065, Japan

[11] Tokyo Rinkai Hosp, Dept Resp Med, Edogawa Ku, 1-4-2 Rinkai Cho, Tokyo 1230086, Japan

[12] Kanagawa Prefectural Ashigarakami Hosp, Dept Gen Med, 866-1 Matsuda Soryo,Matsuda Machi, Ashigarakami, Kanagawa 2580003, Japan

[13] Fujisawa City Hosp, Dept Resp Med, 2-6-1 Fujisawa, Fujisawa, Kanagawa 2518550, Japan

[14] Tokyo Med Univ, Dept Resp Med, Shinjuku Ku, 6-7-1 Nishi Shinjuku, Tokyo 1600023, Japan

[15] Natl Hosp Org Tokyo Med Ctr, Dept Resp Med, 2-5-1Meguro-ku, Higashigaokatokyo 1528902, Japan

[16] St Marianna Univ, Sch Med, Dept Emergency & Crit Care Med, Miyamae Ku, 2-16-1 Sugao, Kawasaki, Kanagawa 2168511, Japan

[17] St Marianna Univ, Sch Med, Div Resp Med, Dept Internal Med,Miyamae Ku, 2-16-1 Sugao, Kawasaki, Kanagawa 2168511, Japan

[18] Kyorin Univ, Dept Resp Med, Sch Med, 6-20-2 Shinkawa, Mitaka, Tokyo 1818611, Japan

[19] Kobe City Hosp Org Kobe City Med Ctr Gen Hosp, Dept Resp Med, Chuo Ku, 2-1-1 Minatojima Minamimachi, Kobe, Hyogo 6500047, Japan

[20] Yokosuka City Hosp, Dept Resp Med, 1-3-2 Nagasaka, Nagasaka, Kanagawa 2400195, Japan

[21] Shonan Fujisawa Tokushukai Hosp, Dept Resp Med, 5-1 Tsujido Kandai, Fujisawa, Kanagawa 2510041, Japan

[22] Int Univ Hlth & Welf Sch Med, Dept Pulm Med, 4-3 Kozunomori, Narita City, Chiba 2868686, Japan

[23] Tokyo Bay Urayasu Ichikawa Med Ctr, Dept Emergency & Crit Care Med, 3-4-32 Todaijima, Urayasu, Chiba 2790001, Japan

[24] Funabashi Cent Hosp, Dept Resp Med, 6-13-10 Kaijin, Funabashi, Chiba 2738556, Japan

[25] Hiroshima Prefectural Hosp, Dept Resp Med, Minami Ku, 1-5-54 Ujina Kanda, Hiroshima, Hiroshima 7348530, Japan

[26] Tosei Gen Hosp, Dept Resp Med & Allergy, 160 Nishioiwake Cho, Seto City, Aichi 4898642, Japan

[27] Ctr Infect Dis, Nagano Prefectural Shinshu Med Ctr, 1332 Suzaka, Suzaka City, Nagano 3828577, Japan

[28] Saiseikai Yokohamashi Tobu Hosp, Dept Resp Med, Tsurumi Ku, 3-6-1 Shimosueyoshi, Yokohama, Kanagawa 2300012, Japan

[29] Japanese Red Cross Soc Saitama Hosp, Dept Resp Med, Chuo Ku, 1-5 Shintoshin, Saitama 3308553, Japan

[30] Gifu Prefectural Gen Med Ctr, Dept Pulm Med, 4-6-1 Noisshiki, Gifu, Gifu 5008717, Japan

[31] Keiyu Hosp, Dept Pulmpnary Med, Nishi Ku, 3-7-3 Minatomirai, Yokohama, Kanagawa 2208521, Japan

[32] Nagoya Univ, Dept Resp Med, Grad Sch Med, Showa Ku, 65 Tsurumai Cho, Nagoya, Aichi 4668550, Japan

来源：

SCIENTIFIC REPORTS | 2021年 / 11卷 / 01期

关键词：

CYTOKINE STORM; SARS;

D O I：

10.1038/s41598-021-90246-y

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Corticosteroids use in coronavirus disease 2019 (COVID-19) is controversial, especially in mild to severe patients who do not require invasive/noninvasive ventilation. Moreover, many factors remain unclear regarding the appropriate use of corticosteroids for COVID-19. In this context, this multicenter, retrospective, propensity score-matched study was launched to evaluate the efficacy of systemic corticosteroid administration for hospitalized patients with COVID-19 ranging in the degree of severity from mild to critically-ill disease. This multicenter, retrospective study enrolled consecutive hospitalized COVID-19 patients diagnosed January-April 2020 across 30 institutions in Japan. Clinical outcomes were compared for COVID-19 patients who received or did not receive corticosteroids, after adjusting for propensity scores. The primary endpoint was the odds ratio (OR) for improvement on a 7-point ordinal score on Day 15. Of 1092 COVID-19 patients analyzed, 118 patients were assigned to either the corticosteroid and non-corticosteroid group, after propensity score matching. At baseline, most patients did not require invasive/noninvasive ventilation (85.6% corticosteroid group vs. 89.8% non-corticosteroid group). The odds of improvement in a 7-point ordinal score on Day 15 was significantly lower for the corticosteroid versus non-corticosteroid group (OR, 0.611; 95% confidence interval [CI], 0.388-0.962; p=0.034). The time to improvement in radiological findings was significantly shorter in the corticosteroid versus non-corticosteroid group (hazard ratio [HR], 1.758; 95% CI, 1.323-2.337; p<0.001), regardless of baseline clinical status. The duration of invasive mechanical ventilation was shorter in corticosteroid versus non-corticosteroid group (HR, 1.466; 95% CI, 0.841-2.554; p=0.177). Of the 106 patients who received methylprednisolone, the duration of invasive mechanical ventilation was significantly shorter in the pulse/semi-pulse versus standard dose group (HR, 2.831; 95% CI, 1.347-5.950; p=0.006). In conclusion, corticosteroids for hospitalized patients with COVID-19 did not improve clinical status on Day 15, but reduced the time to improvement in radiological findings for all patients regardless of disease severity and also reduced the duration of invasive mechanical ventilation in patients who required intubation.Trial registration: This study was registered in the University hospital Medical Information Network Clinical Trials Registry on April 21, 2020 (ID: UMIN000040211).

引用

页数：13

共 50 条

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