重篤な肺感染症の成人のための低用量コルチコステロイド: レビュー
Romain Pirracchio1,2, Balasubramanian Venkatesh3,4, Matthieu Legrand1
1Department of Anesthesia and Perioperative Medicine, University of California San Francisco.
JAMA
|June 12, 2024
まとめ
低用量のコルチコステロイドは,COVID-19や細菌性肺炎のような重症肺感染症の死亡率を大幅に低下させます. これらの治療は,急性呼吸器障害症候群やセプティックショックを患っている重症の患者にとって改善された結果をもたらします.
科学分野:
- クリティカル ケア 医療
- 感染症
- 肺科
背景:
- COVID-19 ,肺炎 ,インフルエンザを含む重度の肺感染症は,成人死亡の主な原因である.
- これらの感染症は,重症な患者にセプティックショックと急性呼吸困難症候群 (ARDS) を引き起こす可能性があり,死亡率は30%から50%です.
研究 の 目的:
- 重度の肺感染症患者の死亡率を減らすための低用量のコルチコステロイドの有効性を評価する.
- 低用量のコルチコステロイドが,セプティックショックやARDSなどの合併症を伴う重症患者への影響を評価する.
主な方法:
- ランダム化臨床試験とサブグループ分析の体系的なレビューとメタ分析.
- COVID-19 患者,地域感染性肺炎,肺胞性肺炎,ARDS を含む研究を含む.
- 低用量コルチコステロイド (毎日≤400mgのヒドロコルチゾン相当) に焦点を当てます.
主要な成果:
- 低用量のコルチコステロイドは,重度のCOVID-19で28日間の死亡率 (23%対26%) と,重度の地域感染性細菌性肺炎で30日間の死亡率 (10%対16%) を減少させた.
- Pneumocystis肺炎のHIV患者 (13% 対 25%) とARDS患者 (34% 対 45%) の死亡率の有意な減少が観察されました.
- 低用量コルチコステロイドで治療された感染性ショックによる地域感染性肺炎では,サブグループ分析により死亡率が低下した (39% vs 51%).
結論:
- 低用量のコルチコステロイド治療は,重度のCOVID-19,地域感染性細菌性肺炎,肺胞性肺炎の死亡率の低下と関連しています.
- これらの薬剤は,セプティックショックまたはARDSによって合併された呼吸器感染症の重症患者にとって有益である.
- 潜在的副作用には,高血糖症,胃腸出血,二次感染が含まれています.
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