PDF(Pubmed)
Abstract：
Corticosteroid therapy for oxygen-free coronavirus disease 2019 (COVID-19) is not recommended due to its negative prognostic impact, but the efficacy of corticosteroids when limited to COVID-19 pneumonia is unclear. We aimed to evaluate the efficacy of corticosteroid monotherapy for patients with COVID-19 pneumonia without supplemental oxygen. We retrospectively reviewed patients with oxygen-free COVID-19 pneumonia at our institute between September 2020 and August 2021 and assessed the use of corticosteroids and the timing of initiation. We classified the patients into the following 2 groups: those who were initiated corticosteroids without developing respiratory failure (early steroid group) and those who were not (standard of care [SOC] group). We used inverse probability of treatment weighting (IPW) to balance between the groups. The primary outcome was the incidence of respiratory failure. A total of 144 patient records were reviewed; 63 patients were in the early steroid group and 81 patients were in the SOC group. Of all patients, 14 (22.2%) and 27 (33.3%) patients in the early steroid and SOC group, respectively, required supplemental oxygen (P = .192). After adjusted by the IPW method, 10 (16.0%) and 32 (40.1%) patients in the early steroid and SOC groups, respectively, required supplemental oxygen (P = .004). The logistic regression analysis indicated that early corticosteroid use was significantly associated with a decreased incidence of respiratory failure (odds ratio; 0.17, 95% confidence intervals; 0.06-0.46, P < .001). Corticosteroid monotherapy may suppress the development of exacerbation requiring oxygen supply in patients with oxygen-free COVID-19 pneumonia.
摘要：
皮质类固醇治疗无氧冠状病毒病2019（COVID-19）不推荐，因为它对预后有负面影响，但仅限于COVID-19肺炎的糖皮质激素的疗效尚不清楚。我们旨在评估无补充氧气的COVID-19肺炎患者使用皮质类固醇单药治疗的疗效。我们回顾性分析了2020年9月至2021年8月在我们研究所接受治疗的无氧COVID-19肺炎患者，并评估了糖皮质激素的使用和开始治疗的时机。我们将患者分为以下2组：开始使用皮质类固醇而未发生呼吸衰竭的患者（早期类固醇组）和未发生呼吸衰竭的患者（标准护理[SOC]组）。我们使用治疗加权的逆概率(IPW)来平衡组间。主要结果是呼吸衰竭的发生率。共审查了144例患者记录；63例患者属于早期类固醇组，81例患者属于SOC组。在所有患者中，14（22.2％）和27（33.3％）患者在早期类固醇和SOC组，分别,需要补充氧气（P=.192）。通过IPW方法调整后，10（16.0％）和32（40.1％）的早期类固醇和SOC组患者，分别,需要补充氧气（P=.004）。Logistic回归分析显示，早期使用皮质类固醇与呼吸衰竭发生率降低显著相关（比值比；0.17，95%置信区间；0.06-0.46，P<.001）。皮质类固醇单一疗法可抑制无氧COVID-19肺炎患者需要氧气供应的恶化的发展。
