PDF(Pubmed)
Abstract：
The COVID-19 pandemic has posed a threat to hospital capacity due to the high number of admissions, which has led to the development of various strategies to release and create new hospital beds. Due to the importance of systemic corticosteroids in this disease, we assessed their efficacy in reducing the length of stay (LOS) in hospitals and compared the effect of 3 different corticosteroids on this outcome.
We conducted a real-world, controlled, retrospective cohort study that analysed data from a hospital database that included 3934 hospitalised patients diagnosed with COVID-19 in a tertiary hospital from April to May 2020. Hospitalised patients who received systemic corticosteroids (CG) were compared with a propensity score control group matched by age, sex and severity of disease who did not receive systemic corticosteroids (NCG). The decision to prescribe CG was at the discretion of the primary medical team.
A total of 199 hospitalized patients in the CG were compared with 199 in the NCG. The LOS was shorter for the CG than for the NCG (median = 3 [interquartile range = 0-10] vs. 5 [2-8.5]; p = 0.005, respectively), showing a 43% greater probability of being hospitalised ≤ 4 days than > 4 days when corticosteroids were used. Moreover, this difference was only noticed in those treated with dexamethasone (76.3% hospitalised ≤ 4 days vs. 23.7% hospitalised > 4 days [p < 0.001]). Serum ferritin levels, white blood cells and platelet counts were higher in the CG. No differences in mortality or intensive care unit admission were observed.
Treatment with systemic corticosteroids is associated with reduced LOS in hospitalised patients diagnosed with COVID-19. This association is significant in those treated with dexamethasone, but no for methylprednisolone and prednisone.
We conducted a real-world, controlled, retrospective cohort study that analysed data from a hospital database that included 3934 hospitalised patients diagnosed with COVID-19 in a tertiary hospital from April to May 2020. Hospitalised patients who received systemic corticosteroids (CG) were compared with a propensity score control group matched by age, sex and severity of disease who did not receive systemic corticosteroids (NCG). The decision to prescribe CG was at the discretion of the primary medical team.
A total of 199 hospitalized patients in the CG were compared with 199 in the NCG. The LOS was shorter for the CG than for the NCG (median = 3 [interquartile range = 0-10] vs. 5 [2-8.5]; p = 0.005, respectively), showing a 43% greater probability of being hospitalised ≤ 4 days than > 4 days when corticosteroids were used. Moreover, this difference was only noticed in those treated with dexamethasone (76.3% hospitalised ≤ 4 days vs. 23.7% hospitalised > 4 days [p < 0.001]). Serum ferritin levels, white blood cells and platelet counts were higher in the CG. No differences in mortality or intensive care unit admission were observed.
Treatment with systemic corticosteroids is associated with reduced LOS in hospitalised patients diagnosed with COVID-19. This association is significant in those treated with dexamethasone, but no for methylprednisolone and prednisone.
摘要：
目标：由于入院人数众多，COVID-19大流行对医院的容量构成了威胁，这导致了各种策略的发展，以释放和创建新的医院病床。由于全身性皮质类固醇在这种疾病中的重要性，我们评估了它们在缩短住院时间(LOS)方面的疗效,并比较了3种不同皮质类固醇对该结局的影响.
方法：我们进行了一个真实世界，控制,回顾性队列研究分析了来自医院数据库的数据，该数据库包括2020年4月至5月在三级医院诊断为COVID-19的3934例住院患者。将接受全身性糖皮质激素（CG）的住院患者与年龄相匹配的倾向评分对照组进行比较，性别和未接受全身性糖皮质激素（NCG）的疾病严重程度。处方CG的决定由基层医疗团队自行决定。
结果：将CG中的199例住院患者与NCG中的199例进行了比较。CG的LOS比NCG短（中位数=3[四分位距=0-10]与5[2-8.5]；分别为p=0.005)，显示当使用皮质类固醇时,≤4天的住院概率比>4天的住院概率高43%。此外，这种差异仅在接受地塞米松治疗的患者中发现（76.3％住院≤4天与23.7%住院>4天[p<0.001])。血清铁蛋白水平,CG中的白细胞和血小板计数较高。没有观察到死亡率或重症监护病房入院的差异。
结论：在确诊为COVID-19的住院患者中，全身性皮质类固醇治疗与LOS降低相关。这种关联在用地塞米松治疗的患者中是显著的，但甲基强的松龙和强的松没有。
方法：我们进行了一个真实世界，
结果：将CG中的199例住院患者与NCG中的199例进行了比较。
结论：在确诊为COVID-19的住院患者中，全身性皮质类固醇治疗与LOS降低相关。
