早期使用類固醇對於新冠肺炎病患預後之影響： 一項採用傾向分數配對法之準實驗研究

Abstract

背景： 類固醇對於重度的新冠肺炎病患，可藉由改變免疫風暴而提升存活率。然而，類固醇的使用可能也會導致病毒複製期延長或是續發感染。至今，類固醇使用的最佳時機學界仍無定論。 方法： 2020年1月至2021年7月間，20歲以上的新冠肺炎成年病患被納入回溯性研究分析，排除條件包含先前曾診斷新冠肺炎以及入院24小時內轉重症或死亡。利用傾向分數配對法來平衡發病十天內有無使用類固醇的兩組病患，並使用羅吉斯回歸和ATET模型來比較兩組病患60天內死亡以及呼吸衰竭的差別。 結果： 總共377位病患納入分析。經傾向分數配對後，在ATET模型中發病十天內接受類固醇的個案有著較高的風險在60天內插管或是死亡(adjusted odds ratio, 1.19; 95% confidence interval [CI], 1.1-1.3)。 類固醇的使用，和發病14天內無法達到解除隔離標準相關（adjusted hazards ratio, 2.62; 95% CI, 1.27-5.4）。 結論： 當短時程使用類固醇是一項對於重度新冠肺炎患者便宜且有效治療的同時，臨床醫師更應該對於輕中症或是疾病前期的新冠肺炎病患使用類固醇的時機保持警覺，以避免可能的不良反應和副作用。

Background For patients with severe COVID-19 disease, corticosteroid helps alter the inflammation and save lives. However, the use of corticosteroid might cause prolonged viral shedding and predispose to secondary infection. The optimal timing of corticosteroid use remained unclear. Methods We included adult patients admitted to National Taiwan University Hospital between January, 2020 and July, 2021 with confirmed SARS-CoV-2 infection. Exclusions included prior COVID-19 diagnosis and those developing critical disease within 24 hours. We used propensity score matching to balance those with and without corticosteroid treatment within 10 days after symptoms onset, and logistic regression with ATET model to determine 60-day mortality or respiratory failure. Findings A total of 377 patients were included in the analysis. After PS matching, for those who received corticosteroid treatment within 10 days after hospitalization had higher risk developing respiratory failure or death in ATET model (adjusted odds ratio, 1.19; 95% confidence interval [CI], 1.1-1.3). The use of steroid was associated with a delay of reaching the criteria of being released from isolation (adjusted hazards ratio, 2.62; 95% CI, 1.27-5.4). Interpretation While short-course corticosteroid therapy is cheap and effective for patients with severe COVID-19, physicians should be alert for optimal timing and potential complication in those with less severe disease and those in early stage of SARS-CoV-19 infection.