机构：[1]Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.[2]Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA.[3]Department of Critical Care Medicine, Xishui People’s Hospital, Huanggang, Hubei, China.[4]Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China.[5]Department of Infectious Disease, Weihai Municipal Hospital, Weihai, Shandong, China.[6]Department of Critical Care Medicine, Wuhan Ninth Hospital, Wuhan, Hubei, China.[7]Department of Critical Care Medicine, Huangshi Central Hospital, Huangshi, Hubei, China.[8]Department of Critical Care Medicine, Huanggang Central Hospital, Huanggang, Hubei, China.[9]Department of Critical Care Medicine, Tuanfeng People’s Hospital, Huanggang, Hubei, China.[10]Department of Critical Care Medicine, Shiyan People’s Hospital, Shiyan, Hubei, China.[11]Department of Critical Care Medicine, Huangshi Aikang Hospital, Huangshi, Hubei, China.[12]Department of Critical Care Medicine, Huangmei People’s Hospital, Huanggang, Hubei, China.[13]Department of Critical Care Medicine, Dongfeng Motor General Hospital, Shiyan, Hubei, China.[14]Department of Ultrasound Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.[15]Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Background Corticoid therapy has been recommended in the treatment of critically ill patients with COVID-19, yet its efficacy is currently still under evaluation. We investigated the effect of corticosteroid treatment on 90-day mortality and SARS-CoV-2 RNA clearance in severe patients with COVID-19. Methods 294 critically ill patients with COVID-19 were recruited between December 30, 2019 and February 19, 2020. Logistic regression, Cox proportional-hazards model and marginal structural modeling (MSM) were applied to evaluate the associations between corticosteroid use and corresponding outcome variables. Results Out of the 294 critically ill patients affected by COVID-19, 183 (62.2%) received corticosteroids, with methylprednisolone as the most frequently administered corticosteroid (175 accounting for 96%). Of those treated with corticosteroids, 69.4% received corticosteroid prior to ICU admission. When adjustments and subgroup analysis were not performed, no significant associations between corticosteroids use and 90-day mortality or SARS-CoV-2 RNA clearance were found. However, when stratified analysis based on corticosteroid initiation time was performed, there was a significant correlation between corticosteroid use (<= 3 day after ICU admission) and 90-day mortality (logistic regression adjusted for baseline: OR 4.49, 95% CI 1.17-17.25, p = 0.025; Cox adjusted for baseline and time varying variables: HR 3.89, 95% CI 1.94-7.82, p < 0.001; MSM adjusted for baseline and time-dependent variants: OR 2.32, 95% CI 1.16-4.65, p = 0.017). No association was found between corticosteroid use and SARS-CoV-2 RNA clearance even after stratification by initiation time of corticosteroids and adjustments for confounding factors (corticosteroids use <= 3 days initiation vs no corticosteroids use) using MSM were performed. Conclusions Early initiation of corticosteroid use (<= 3 days after ICU admission) was associated with an increased 90-day mortality. Early use of methylprednisolone in the ICU is therefore not recommended in patients with severe COVID-19.
基金：
Zhongnan Hospital of Wuhan University Science, Technology and Innovation Seed Fund [znpy2019059]
第一作者机构：[1]Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
共同第一作者：
通讯作者：
推荐引用方式(GB/T 7714)：
Li Yiming,Meng Qinghe,Rao Xin,et al.Corticosteroid therapy in critically ill patients with COVID-19: a multicenter, retrospective study[J].CRITICAL CARE.2020,24(1):doi:10.1186/s13054-020-03429-w.
APA：
Li, Yiming,Meng, Qinghe,Rao, Xin,Wang, Binbin,Zhang, Xingguo...&Wang, Dawei.(2020).Corticosteroid therapy in critically ill patients with COVID-19: a multicenter, retrospective study.CRITICAL CARE,24,(1)
MLA：
Li, Yiming,et al."Corticosteroid therapy in critically ill patients with COVID-19: a multicenter, retrospective study".CRITICAL CARE 24..1(2020)
医学