重症COVID–19患者における侵襲的人工呼吸管理中のステロイドの投与終了と28日死亡率の関連の検討，後方視的コホート研究(Association between corticosteroid treatment termination during invasive mechanical ventilation and 28–day mortality in severe COVID–19 patients, a retrospective cohort study)

Abstract

Aims : To investigate the association between corticosteroid treatment termination during invasive mechanical ventilation and 28–day mortality in severe COVID–19 patients. Method s: The study was a single–center, retrospective cohort study of COVID–19 patients undergoing invasive mechanical ventilation on their scheduled corticosteroid termination day between March 1, 2020, and June 30, 2021. The scheduled corticosteroid termination day was scheduled 10 days after initiation of dexamethasone 6mg orally or 6.6mg intravenously. Patients who terminated corticosteroids during the ventilatory period and did not receive corticosteroids thereafter were defined as the termination group, whereas patients who continued to receive corticosteroids in some form after the scheduled corticosteroid termination day were defined as the continuation group. The primary endpoint was 28–day mortality, and the difference was evaluated using the log–rank test. Results : The 28–day mortality was found to be 61% (14 of 23 patients) in the termination group, which was significantly higher than the 28–day mortality of 22% (5 of 23 patients) in the continuation group (Hazard Ratio: 3.82, 95% CI: 1.37–10.68; p=0.005). Conclusions : In severe COVID–19 patients, corticosteroid termination during invasive ventilation is associated with an increased 28–day mortality.