医学
皮质类固醇
甲基强的松龙
逻辑回归
内科学
2019年冠状病毒病(COVID-19)
回顾性队列研究
比例危险模型
病危
子群分析
置信区间
传染病(医学专业)
疾病
作者
Yiming Li,Qinghe Meng,Xiaolan Rao,Binbin Wang,Xingguo Zhang,Fang Dong,Tao Yu,Zhongyi Li,Hao Feng,Jinpeng Zhang,Xiangyang Chen,Hunian Li,Yi Cheng,Xiaoyang Hong,Xiang Wang,Yimei Yin,Zhongheng Zhang,Dawei Wang
出处
期刊:Critical Care
[Springer Nature]
日期:2020-12-01
卷期号:24 (1)
被引量:33
标识
DOI:10.1186/s13054-020-03429-w
摘要
Abstract Background Corticoid therapy has been recommended in the treatment of critically ill patients with COVID-19, yet its efficacy is currently still under evaluation. We investigated the effect of corticosteroid treatment on 90-day mortality and SARS-CoV-2 RNA clearance in severe patients with COVID-19. Methods 294 critically ill patients with COVID-19 were recruited between December 30, 2019 and February 19, 2020. Logistic regression, Cox proportional-hazards model and marginal structural modeling (MSM) were applied to evaluate the associations between corticosteroid use and corresponding outcome variables. Results Out of the 294 critically ill patients affected by COVID-19, 183 (62.2%) received corticosteroids, with methylprednisolone as the most frequently administered corticosteroid (175 accounting for 96%). Of those treated with corticosteroids, 69.4% received corticosteroid prior to ICU admission. When adjustments and subgroup analysis were not performed, no significant associations between corticosteroids use and 90-day mortality or SARS-CoV-2 RNA clearance were found. However, when stratified analysis based on corticosteroid initiation time was performed, there was a significant correlation between corticosteroid use (≤ 3 day after ICU admission) and 90-day mortality (logistic regression adjusted for baseline: OR 4.49, 95% CI 1.17–17.25, p = 0.025; Cox adjusted for baseline and time varying variables: HR 3.89, 95% CI 1.94–7.82, p < 0.001; MSM adjusted for baseline and time-dependent variants: OR 2.32, 95% CI 1.16–4.65, p = 0.017). No association was found between corticosteroid use and SARS-CoV-2 RNA clearance even after stratification by initiation time of corticosteroids and adjustments for confounding factors (corticosteroids use ≤ 3 days initiation vs no corticosteroids use) using MSM were performed. Conclusions Early initiation of corticosteroid use (≤ 3 days after ICU admission) was associated with an increased 90-day mortality. Early use of methylprednisolone in the ICU is therefore not recommended in patients with severe COVID-19.
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