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“…In the latest April 14, 2021, Infectious Diseases Society of America Guidelines (IDSA) on the treatment and management of patients with COVID-19 revised Ver-sion4.2.0 of the guidelines suggest tocilizumab in addition to standard of care rather than standard of care alone [33]. In our other studies, glucocorticoid, thymosin α1 and immunoglobulin therapy were found to be associated with the outcome of critically ill patients with COVID-19 [34][35][36][37].…”
Section: Discussionmentioning
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“…In the latest April 14, 2021, Infectious Diseases Society of America Guidelines (IDSA) on the treatment and management of patients with COVID-19 revised Ver-sion4.2.0 of the guidelines suggest tocilizumab in addition to standard of care rather than standard of care alone [33]. In our other studies, glucocorticoid, thymosin α1 and immunoglobulin therapy were found to be associated with the outcome of critically ill patients with COVID-19 [34][35][36][37].…”
Section: Discussionmentioning
“…また本研究でステロイドを10日間で投与終了したほうが予後不良であった理由の一つとして二次性の器質化肺炎の合併の可能性が考えられる。一般的にCOVID–19患者に対するステロイドの投与は短期間が良いとする報告が多い 3) , 4) 。7日間を超えるステロイドの投与は60日死亡率に影響を与えない可能性を示唆する報告もある 11) 。しかしステロイド投与終了後に再度炎症反応の上昇や呼吸不全の増悪を認めるなど二次性の器質化肺炎を疑った場合はステロイドの長期間の投与が望ましいとされる 5) , 12) 。実際に入室後にフォローアップのCT検査が実施された患者の中で,読影レポートで器質化肺炎の疑いがあるとされた症例は継続群において22名中13名(59%),終了群において16名中5名(31%)認めており,重症COVID–19患者の一部には二次性の器質化肺炎が合併している可能性が示唆された。先述の過剰な免疫反応がステロイドの終了とともに顕在化した可能性が考えられる一方で,一部の患者においては二次性の器質化肺炎の合併が転帰不良に寄与した可能性も考えられた。ステロイドの長期投与を実施するか判断する際には,CT検査を行い器質化肺炎の所見の有無を確認することは有用である可能性がある。…”
Section: 考  察unclassified
“…Subsequently, other systematic reviews have been published with a greater representation of RCTs, confirming the beneficial effect of corticosteroids, including a reduction in the mortality rate of patients with severe or critical COVID-19 and the need for mechanical ventilation [ 83 - 89 ]. The Cochrane collaboration updates through an ongoing systematic review approach the evidence on the efficacy and safety of CS in the treatment of people with COVID-19.…”
Section: Is the Issue Of The Indication Of Corticosteroids At Differe...mentioning