國家衛生研究院 NHRI:Item 3990099045/15687
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    题名: Effect of early dexamethasone on outcomes of COVID-19: A quasi-experimental study using propensity score matching
    作者: Liu, WD;Wang, JT;Shih, MC;Chen, KH;Huang, ST;Huang, CF;Chang, TH;Tsai, MJ;Kuo, PH;Yeh, YC;Tsai, WC;Pan, MY;Li, GC;Chen, YJ;Lin, KY;Huang, YS;Cheng, A;Chen, PY;Pan, SC;Sun, HY;Ku, SC;Chang, SY;Sheng, WH;Fang, CT;Hung, CC;Chen, YC;Ho, YL;Wu, MS;Chang, SC
    贡献者: National Institute of Infectious Diseases and Vaccinology
    摘要: BACKGROUND: The RECOVERY trial demonstrated that the use of dexamethasone is associated with a 36% lower 28-day mortality in hospitalized patients with COVID-19 on invasive mechanical ventilation. Nevertheless, the optimal timing to start dexamethasone remains uncertain. METHODS: We conducted a quasi-experimental study at National Taiwan University Hospital (Taipei, Taiwan) using propensity score matching to simulate a randomized controlled trial to receive or not to receive early dexamethasone (6 mg/day) during the first 7 days following the onset of symptoms. Treatment was standard protocol-based, except for the timing to start dexamethasone, which was left to physicians' decision. The primary outcome is 28-day mortality. Secondary outcomes include secondary infection within 60 days and fulfilling the criteria of de-isolation within 20 days. RESULTS: A total of 377 patients with COVID-19 were enrolled. Early dexamethasone did not decrease 28-day mortality in all patients (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.97-1.10) or in patients who required O2 for severe/critical disease at admission (aOR, 1.05; 95%CI, 0.94-1.18); but is associated with a 24% increase in superinfection in all patients (aOR, 1.24; 95% CI, 1.12-1.37) and a 23% increase in superinfection in patients of O2 for several/critical disease at admission (aOR, 1.23; 95% CI, 1.02-1.47). Moreover, early dexamethasone is associated with a 42% increase in likelihood of delayed clearance of SARS-CoV-2 virus (adjusted hazard ratio, 1.42; 95% CI, 1.01-1.98). CONCLUSION: An early start of dexamethasone (within 7 days after the onset of symptoms) could be harmful to hospitalized patients with COVID-19.
    日期: 2024-06
    關聯: Journal of Microbiology, Immunology, and Infection. 2024 Jun;57(3):414-425.
    Link to: http://dx.doi.org/10.1016/j.jmii.2024.02.002
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=1684-1182&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:001251074400001
    Cited Times(Scopus): https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85186171764
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