高剂量皮质类固醇在COVID-19严重至重症患者中的使用:全国性基于人口的匹配队列研究
Raeseok Lee1,2, Sung-Yeon Cho1,2, Dong-Gun Lee1,3
1Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Journal of Korean medical science
|September 4, 2024
概括
高剂量皮质类固醇治疗严重的COVID-19会增加死亡风险和患肺阿斯伯吉洛症的机会. 建议使用标准剂量的类固醇,以便在重症患者中获得更好的结果.
科学领域:
- 关键护理医学 关键护理医学
- 传染病 传染病 传染病
- 药理学 药理学是指药理学的学科.
背景情况:
- 系统性皮质类固醇是严重COVID-19的标准.
- 在COVID-19中高剂量的皮质类固醇疗效和安全性的现实数据有限.
研究的目的:
- 为了评估高剂量皮质类固醇在严重至重症COVID-19患者的实际有效性和安全性.
- 评估高剂量类固醇对死亡率和COVID-19相关的肺炎 (CAPA) 的影响.
主要方法:
- 在韩国进行全国范围,基于人口的,匹配的队列研究 (2020年1月 - 2021年6月).
- 包括使用系统性皮质类固醇的严重至危急的COVID-19患者.
- 高剂量定义为>6毫克/天德克萨梅他;使用回归模型分析死亡率和CAPA.
主要成果:
- 高剂量的皮质类固醇使用独立地与28天 (aHR,1.48) 和90天 (aHR,1.63) 的全因死亡率增加有关.
- 在使用鼻但不使用机械通风的子组中观察到增加的死亡风险.
- 高剂量的类固醇与CAPA发育有关联 (aHR,2.97).
结论:
- 在严重的COVID-19中使用高剂量的皮质类固醇与较高的死亡率有关.
- 在使用高剂量的类固醇时,观察到CAPA发育增加的趋势.
相关概念视频
COPD: Management Using Bronchodilators and Corticosteroids
188
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
188
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
98
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
98
Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
228
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
228
Pulmonary Tuberculosis I
227
Tuberculosis, often called TB, is a contagious illness primarily caused by Mycobacterium tuberculosis. It mainly affects the lung parenchyma but can also impact other body parts.
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
227
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
145
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
145
Acute Respiratory Failure-II
186
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
186


