Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report
BACKGROUNDCoronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death.METHODSIn this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison.RESULTSA total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval , 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55).CONCLUSIONSIn patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936. opens in new tab; ISRCTN number, 50189673. opens in new tab.)原文地址：https://www.nejm.org/doi/full/10.1056/NEJMoa2021436，可以去学习一下。 地塞米松治疗Covid-19的住院患者—初步报告 [复制链接]
背景
2019年冠状病毒病（Covid-19）与弥漫性肺损伤有关。糖皮质激素可调节炎症介导的肺损伤，从而减少发展为呼吸衰竭和死亡。
方法
在这项比较开放性的对照试验中，我们比较了接受Covid-19住院治疗的患者的一系列可能治疗方法，我们随机分配患者接受口服或静脉地塞米松治疗（每天6 mg，一次）最多10天或仅接受常规护理。主要结局为28天死亡率。在这里，我们报告了此比较的初步结果。
结果
共有2104例患者被分配接受地塞米松治疗，4321例接受常规治疗。总体而言，地塞米松组中的482例患者（22.9％）和常规护理组中的1110例患者（25.7％）在随机分组后的28天内死亡（年龄调整率，0.83； 95％置信区间，0.75至0.93） ； P <0.001）。死亡率的比例和绝对组间差异根据患者在随机分组时所接受的呼吸支持水平而有很大差异。在接受有创机械通气的患者中，地塞米松组的死亡发生率低于常规护理组（29.3％比41.4％；比率为0.64； 95％CI为0.51至0.81）和接受氧气治疗的患者无创机械通气（23.3％vs. 26.2％;比率，0。82; 95％CI为0.72至0.94），但在随机分组中未接受呼吸支持的人群中则没有（17.8％vs. 14.0％；比率为1.19； 95％CI为0.91至1.55）。
结论
在接受Covid-19住院治疗的患者中，在随机接受单独有创机械通气或仅接受氧气治疗的患者中，使用地塞米松可降低28天死亡率，但未接受呼吸支持的患者则没有。（由医学研究委员会和美国国立卫生研究院等机构资助； RECOVERY ClinicalTrials.gov号NCT04381936。在新标签中打开；ISRCTN号50189673.在新标签中打开。）
页:
[1]