PDF(Pubmed)
Abstract：
Baricitinib is considered a first-line treatment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected adult patients with an associated cytokine storm syndrome (CSS). Our objective was to compare rates of secondary infections and long-term outcomes of elderly and non-elderly patients who received baricitinib for COVID-19. We conducted a single-centre observational study between November 2020 and September 2023, focusing on hospitalized adult SARS-CoV-2 patients with CSS, categorized as elderly (≥ 65 years) and non-elderly (< 65 years). Enrolment, severity stratification, and diagnosis of infectious complications followed predefined criteria. Outcomes of all-cause mortality and rates of non-severe and severe secondary infections were assessed at 1-year post-treatment initiation. Kaplan-Meier analysis was performed for survival analysis. In total, 490 patients were enrolled (median age 65 ± 23 (21-100) years (years, median ± IQR, min-max); 49.18% elderly; 59.59% male). Elderly patients were admitted to the hospital significantly earlier (7 ± 5 days vs. 8 ± 4 days; p = 0.02), experienced a higher occurrence of severe COVID-19 (121/241, 50.21% vs. 98/249, 39.36%; p = 0.02), and required the use of non-invasive ventilation at baseline (167/225, 74.22% vs. 153/236, 64.83%; p = 0.03). At 1 year, all-cause mortality was significantly higher in the elderly subgroup (111/241, 46.06% vs. 29/249, 11.65%; p < 0.01). At 90 days and 1 year, rates of any severe secondary infection were also more prevalent among the elderly (56/241, 23.24% vs. 37/249 14.86%; p = 0.02 and 58/241, 24.07% vs. 39/249, 15.66%; p = 0.02). In conclusion, elderly SARS-CoV-2-infected patients experience a more severe clinical course, higher secondary infection rates, and increased risk for long-term mortality, regardless of immunomodulatory therapy.
摘要：
Baricitinib被认为是治疗严重急性呼吸道综合症冠状病毒2（SARS-CoV-2）感染的成年患者相关细胞因子风暴综合症（CSS）的一线治疗方法。我们的目标是比较接受巴利替尼治疗COVID-19的老年和非老年患者的继发感染率和长期结局。我们在2020年11月至2023年9月之间进行了一项单中心观察性研究，重点是患有CSS的住院成年SARS-CoV-2患者，分为老年人（≥65岁）和非老年人（<65岁）。入学人数,严重性分层，感染性并发症的诊断遵循预定标准。在治疗开始后1年评估全因死亡率和非严重和严重继发感染的发生率。进行Kaplan-Meier分析用于生存分析。总的来说,纳入490例患者(中位年龄65±23(21-100)岁(岁，中位数±IQR，最小-最大）；49.18%老年；59.59%男性）。老年患者入院时间明显提前（7±5天与8±4天；p=0.02），经历了更高的严重COVID-19发生率（121/241，50.21%与98/249，39.36%；p=0.02），并且需要在基线时使用无创通气（167/225，74.22%vs.153/236，64.83%；p=0.03）。在1年,老年亚组的全因死亡率明显更高(111/241，46.06%vs.29/249，11.65%；p<0.01）。在90天和1年，任何严重继发感染率在老年人中也更普遍(56/241，23.24%vs.37/24914.86%；p=0.02和58/241，24.07%与39/249，15.66%；p=0.02）。总之,老年SARS-CoV-2感染患者经历更严重的临床过程，较高的继发感染率，长期死亡的风险增加，无论免疫调节治疗。
