A retrospective cohort study of methylprednisolone therapy in severe patients with COVID-19 pneumonia
Autor: | Qi He, Weiwei Jiang, Nianguo Dong, Yin Wang, Pan Zhou, Cheng Wang, Qiaoxia Tong, Baoju Wang |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
0301 basic medicine
China Cancer Research medicine.medical_specialty ARDS Pneumonia Viral lcsh:Medicine Lung injury Methylprednisolone Gastroenterology Betacoronavirus 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Genetics Humans Medicine Respiratory system Diffuse alveolar damage Pandemics lcsh:QH301-705.5 Retrospective Studies Original Investigation Respiratory Distress Syndrome Respiratory tract diseases SARS-CoV-2 business.industry lcsh:R COVID-19 Retrospective cohort study medicine.disease Research Highlight Coronavirus Pneumonia 030104 developmental biology lcsh:Biology (General) 030220 oncology & carcinogenesis Infectious diseases Coronavirus Infections business Cytokine storm medicine.drug |
Zdroj: | Signal Transduction and Targeted Therapy Signal Transduction and Targeted Therapy, Vol 5, Iss 1, Pp 1-3 (2020) JAMA Intern Med |
ISSN: | 2059-3635 2095-9907 |
Popis: | IMPORTANCE: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Risk factors for the clinical outcomes of COVID-19 pneumonia have not yet been well delineated. OBJECTIVE: To describe the clinical characteristics and outcomes in patients with COVID-19 pneumonia who developed acute respiratory distress syndrome (ARDS) or died. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 201 patients with confirmed COVID-19 pneumonia admitted to Wuhan Jinyintan Hospital in China between December 25, 2019, and January 26, 2020. The final date of follow-up was February 13, 2020. EXPOSURES: Confirmed COVID-19 pneumonia. MAIN OUTCOMES AND MEASURES: The development of ARDS and death. Epidemiological, demographic, clinical, laboratory, management, treatment, and outcome data were also collected and analyzed. RESULTS: Of 201 patients, the median age was 51 years (interquartile range, 43-60 years), and 128 (63.7%) patients were men. Eighty-four patients (41.8%) developed ARDS, and of those 84 patients, 44 (52.4%) died. In those who developed ARDS, compared with those who did not, more patients presented with dyspnea (50 of 84 [59.5%] patients and 30 of 117 [25.6%] patients, respectively [difference, 33.9%; 95% CI, 19.7%-48.1%]) and had comorbidities such as hypertension (23 of 84 [27.4%] patients and 16 of 117 [13.7%] patients, respectively [difference, 13.7%; 95% CI, 1.3%-26.1%]) and diabetes (16 of 84 [19.0%] patients and 6 of 117 [5.1%] patients, respectively [difference, 13.9%; 95% CI, 3.6%-24.2%]). In bivariate Cox regression analysis, risk factors associated with the development of ARDS and progression from ARDS to death included older age (hazard ratio [HR], 3.26; 95% CI 2.08-5.11; and HR, 6.17; 95% CI, 3.26-11.67, respectively), neutrophilia (HR, 1.14; 95% CI, 1.09-1.19; and HR, 1.08; 95% CI, 1.01-1.17, respectively), and organ and coagulation dysfunction (eg, higher lactate dehydrogenase [HR, 1.61; 95% CI, 1.44-1.79; and HR, 1.30; 95% CI, 1.11-1.52, respectively] and D-dimer [HR, 1.03; 95% CI, 1.01-1.04; and HR, 1.02; 95% CI, 1.01-1.04, respectively]). High fever (≥39 °C) was associated with higher likelihood of ARDS development (HR, 1.77; 95% CI, 1.11-2.84) and lower likelihood of death (HR, 0.41; 95% CI, 0.21-0.82). Among patients with ARDS, treatment with methylprednisolone decreased the risk of death (HR, 0.38; 95% CI, 0.20-0.72). CONCLUSIONS AND RELEVANCE: Older age was associated with greater risk of development of ARDS and death likely owing to less rigorous immune response. Although high fever was associated with the development of ARDS, it was also associated with better outcomes among patients with ARDS. Moreover, treatment with methylprednisolone may be beneficial for patients who develop ARDS. |
Databáze: | OpenAIRE |
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