Can critically ill patients with COVID-19 benefit from systemic corticosteroids? Too early to draw conclusions

doi:10.3877/cma.j.issn.2096-1537.2021.03.002

Abstract

Abstract:

The administration of corticosteroids during COVID-19 pandemic has been on a debate. Since the results of the studies on corticosteroids for COVID-19 have been published, thorough and comprehensive interpretation of these results is of great significance for future clinical applications.

Key words: Coronavirus disease 2019, Corticosteroids, Prognosis

Ming Xue, Hui Chen, Jianfeng Xie, Yi Yang. Can critically ill patients with COVID-19 benefit from systemic corticosteroids? Too early to draw conclusions[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(03): 204-207.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2021.03.002

https://icu.cma-cmc.com.cn/EN/Y2021/V07/I03/204

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References 8

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纳入研究	目标样本例数	实际完成例数	激素种类	剂量及疗程	原始研究主要结局指标	28 d病死率［例（%）］	不良事件定义
DEXA-COVID 19	200	19	地塞米松	静脉：20 mg/d ×5 d后，10 mg/d×5 d	60 d病死率	4（21）	脓毒症、肺炎等继发感染；肺栓塞
CoDEX	350	256	地塞米松	静脉：20 mg/d×5 d后，10 mg/d ×5 d	无机械通气天数	145（56）	死亡；感染；胰岛素使用
RECOVERY	—	1007	地塞米松	口服或静脉：6 mg/d	28 d病死率	378（37）	激素使用相关死亡；机械通气；透析；心律失常；其他被认为与激素相关的事件
COVID STEROID	1000	29	氢化可的松	静脉：200 mg/d×7 d（持续泵入或50 mg/6 h）	28 d内无器官支持天数	8（28）	新发的脓毒症、侵袭性真菌感染；严重消化道出血；过敏反应
REMAP-CAP	—	197	氢化可的松	静脉：50 mg/6 h×7 d	21 d ICU内无器官支持天数及住院病死率复合指标	55（28）	符合免疫宿主损伤表现的任意一项（不包括研究方案既定的结局指标）
CAPE COVID	290	148	氢化可的松	连续静脉应用8 d或14 d（200 mg/d×4 d或7 d；100 mg/d×2 d或4 d；50 mg/d×2 d或3 d）	21 d治疗失败（死亡或仍依赖机械通气或者高流量吸氧）	31（21）^a	除研究方案中的认定或预期发生的任何事件
Steroids-SARI	80	47	甲强龙	静脉：40 mg/12 h×7 d	7、14 d肺损伤评分	26（55）^b	继发细菌性感染；气压伤；严重高血糖；需要输血的消化道出血；获得性肌无力

纳入研究	目标样本例数	实际完成例数	激素种类	剂量及疗程	原始研究主要结局指标	28 d病死率［例（%）］	不良事件定义
DEXA-COVID 19	200	19	地塞米松	静脉：20 mg/d ×5 d后，10 mg/d×5 d	60 d病死率	4（21）	脓毒症、肺炎等继发感染；肺栓塞
CoDEX	350	256	地塞米松	静脉：20 mg/d×5 d后，10 mg/d ×5 d	无机械通气天数	145（56）	死亡；感染；胰岛素使用
RECOVERY	—	1007	地塞米松	口服或静脉：6 mg/d	28 d病死率	378（37）	激素使用相关死亡；机械通气；透析；心律失常；其他被认为与激素相关的事件
COVID STEROID	1000	29	氢化可的松	静脉：200 mg/d×7 d（持续泵入或50 mg/6 h）	28 d内无器官支持天数	8（28）	新发的脓毒症、侵袭性真菌感染；严重消化道出血；过敏反应
REMAP-CAP	—	197	氢化可的松	静脉：50 mg/6 h×7 d	21 d ICU内无器官支持天数及住院病死率复合指标	55（28）	符合免疫宿主损伤表现的任意一项（不包括研究方案既定的结局指标）
CAPE COVID	290	148	氢化可的松	连续静脉应用8 d或14 d（200 mg/d×4 d或7 d；100 mg/d×2 d或4 d；50 mg/d×2 d或3 d）	21 d治疗失败（死亡或仍依赖机械通气或者高流量吸氧）	31（21）^a	除研究方案中的认定或预期发生的任何事件
Steroids-SARI	80	47	甲强龙	静脉：40 mg/12 h×7 d	7、14 d肺损伤评分	26（55）^b	继发细菌性感染；气压伤；严重高血糖；需要输血的消化道出血；获得性肌无力

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