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

Critical Care

Dechang Chen¹  Ming Zhong²  Yun Feng³  Jie Xu⁴  Xin Zhou⁵  Chunling Du⁶  Chaomin Wu⁷  Yuanlin Song⁸  Cuicui Chen⁹  Yuye Zhang⁹  Yen-cheng Chao⁹  Lu Wang⁹  Chunxue Bai⁹  Xianglin Hu⁹  Jie Hu⁹  Xiaoyan Chen⁹  Dongni Hou⁹  Jinjun Jiang⁹  Juan Song⁹  Weining Xiong^1,10  Jinfu Xu^1,11  Junhua Zheng^1,12  Yanping Cai^1,13  Fengyun Gong^1,13 

[1]Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

[2]Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China

[3]Department of Gastroenterology, Shanghai First People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

[4]Department of Infectious Diseases, Fengxian Guhua Hospital, Shanghai, China

[5]Department of Pulmonary Medicine, Shanghai First People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

[6]Department of Pulmonary and Critical Care Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China

[7]Department of Pulmonary and Critical Care Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China

[8]Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China

[9]Department of Pulmonary and Critical Care Medicine, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China

[10]Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China

[11]Shanghai Respiratory Research Institute, Shanghai, China

[12]National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China

[13]Jinshan Hospital of Fudan University, Shanghai, China

[14]Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China

[15]Department of Respiratory and Critical Care Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

[16]Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Shanghai, China

[17]Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

[18]Infection Division, Wuhan Jin Yin-Tan Hospital, Wuhan, China

关键词: Corticosteroids;    Coronavirus disease 2019;    Severe acute respiratory syndrome coronavirus 2;    Mortality;    Propensity score;    Methylprednisolone;   

DOI  :  10.1186/s13054-020-03340-4

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsIn 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.ResultsA 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.ConclusionIn 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.

【 授权许可】

CC BY