■尚不清楚哪种皮质类固醇方案对COVID-19肺炎具有最佳疗效。
■这项研究的目的是比较2种不同方案治疗COVID-19引起的急性呼吸窘迫综合征(ARDS)的临床结果:每12小时1mg/kg的甲基强的松龙(低剂量组)和每12小时1mg/kg甲基强的松龙(高剂量组)后3天的1000mg/天脉冲治疗。
■在这项随机临床试验中,因COVID-19导致轻度至中度ARDS的患者被随机分配接受低剂量(n=47)或高剂量(n=48)静脉注射甲基强的松龙方案.两组进行年龄匹配,性别,体重指数(BMI),合并症,白细胞,淋巴细胞,中性粒细胞/淋巴细胞,血小板,血红蛋白,和炎症标志物(红细胞沉降率[ESR],C反应蛋白[CRP],和铁蛋白)。两种方案均在入院时开始并持续10天。评估临床结果和继发并发症。
■评估住院结局,重症监护病房(ICU)住院时间无差异(5.4±4.6vs.4.5±4.9;P=0.35),总住院时间(8±3.1vs.6.9±3.4;P=0.1),有创通气的需求率(29.2%vs.36.2%;P=0.4)或非侵入性通气(16.6%vs23.4%;P=0.4),低剂量和高剂量组之间的血液灌流(16.6%对11.3%;P=0.3)。ARDS导致的死亡率没有显着差异(29.2%与38.3%;P=0.3)和感染性休克(4.2%vs.6.4%;低剂量组和高剂量组之间的P=0.3)。与低剂量组相比,高剂量组患者的细菌性肺炎合并感染事件明显高于低剂量组(18.7%vs10.6%;P=0.01)。
■静脉注射甲基强的松龙的辅助冲击疗法并未改善因COVID-19引起的轻中度ARDS患者的院内临床预后。在接受更高剂量的类固醇的情况下,应考虑细菌性肺炎的风险更高。
UNASSIGNED: It remains unclear which formulation of the corticosteroid regimen has the optimum efficacies on COVID-19 pneumonia.
UNASSIGNED: The aim of this study was to compare the clinical outcomes of 2 different regimens in the treatment of acute respiratory distress syndrome (ARDS) caused by COVID-19: Methylprednisolone at a dose of 1 mg/kg every 12 hours (low-dose group) and 1000 mg/day pulse therapy for 3 days following 1 mg/kg methylprednisolone every 12 hours (high-dose group).
UNASSIGNED: In this randomized clinical trial, patients with mild to moderate ARDS due to COVID-19 were randomly assigned to receive either low-dose (n = 47) or high-dose (n = 48) intravenous methylprednisolone regimens. Two groups were matched for age, gender, body mass index (BMI), comorbidities, leukocytes, lymphocytes, neutrophil/lymphocyte, platelet, hemoglobin, and inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and ferritin). Both regimens were initiated upon admission and continued for 10 days. The clinical outcome and secondary complications were evaluated.
UNASSIGNED: Evaluating in-hospital outcomes, no difference was revealed in the duration of intensive care unit (ICU) stays (5.4 ± 4.6 vs. 4.5 ± 4.9; P = 0.35), total hospital stays (8 ± 3.1 vs. 6.9 ± 3.4; P = 0.1), requirement rate for invasive ventilation (29.2% vs. 36.2%; P = 0.4) or non-invasive ventilation (16.6% vs 23.4%; P = 0.4), and hemoperfusion (16.6% vs 11.3%; P = 0.3) between the low- and high-dose groups. There was no significant difference in fatality due to ARDS (29.2% vs. 38.3%; P = 0.3) and septic shock (4.2% vs. 6.4%; P = 0.3) between the low- and high-dose groups. Patients in the high-dose group had significantly higher bacterial pneumonia co-infection events compared with those in the low-dose group (18.7% vs 10.6%; P = 0.01).
UNASSIGNED: The use of adjuvant pulse therapy with intravenous methylprednisolone did not result in improved in-hospital clinical outcomes among patients with mild to moderate ARDS due to COVID-19. A higher risk of bacterial pneumonia should be considered in such cases as receiving a higher dose of steroids.