Kritik Durumdaki COVID-19 Hastalarında Kümülatif Kortikosteroid Dozlarının Karşılaştırılması
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Kritik Durumdaki COVID-19 Hastalarında Kümülatif Kortikosteroid Dozlarının Karşılaştırılması

Mediterr J Infect Microb Antimicrob 2023;12:1-1 DOI: 10.4274/mjima.galenos.2023.2022.1
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Giriş: Deksametazon, Koronavirüs hastalığı-2019’da (COVID-19) sağkalımı iyileştirdiği gösterilen ilk ilaçtır. Bununla birlikte, farklı kümülatif dozlarda kortikosteroidlerin hastalık sonlanımı üzerindeki etkilerinin açıklığa kavuşturulması gerekmektedir. Çalışmamızın amacı, farklı kümülatif sistemik kortikosteroid dozlarına göre COVID-19 hastalarında klinik özellikleri, hastane mortalitesini ve sekonder enfeksiyonları karşılaştırmaktır.

Gereç ve Yöntem: Yoğun bakım ünitesine 21 Mart 2020 ile 20 Eylül 2020 tarihleri arasında kabul edilen COVID-19 hastaları, RECOVERY çalışmasına dayalı olarak [10 gün 6 mg deksametazon (32 mg metilprednizolona eşdeğer)] sistemik kortikosteroid almayan, düşük-orta kümülatif doz kortikosteroid alan (toplam doz ≤320 mg metilprednizolon veya eşdeğer dozlarda kortikosteroid) ve yüksek kümülatif doz kortikosteroid (toplam doz >320 mg metilprednizolon eşdeğeri) alan hastalar olacak şekilde retrospektif olarak gruplandırıldı.

Bulgular: Yüz otuz dört hastanın 35’i (%26) sistemik kortikosteroid almamış, 34’ü (%25) düşük-orta kümülatif doz kortikosteroid ve 65’i (%49) yüksek kümülatif doz kortikosteroid almıştır. Sekonder bakteriyel (%31,4’e karşı %41,2 ve %63,1, p=0,006) ve fırsatçı enfeksiyonlar (%2,9’a karşı %5,9 ve %21,5, p=0,011) düşük-orta ve yüksek doz kortikosteroid gruplarında kortikosteroid uygulanmayan gruba kıyasla daha fazla görüldü. Hastane mortalitesi steroid almayan hastalarda %20 iken, düşük-orta ve yüksek doz kortikosteroid alan hastalarda sırasıyla %29,4 ve %46,2 idi (p=0,012). Yüksek kümülatif doz sistemik kortikosteroid, hastane mortalitesi [Odds oranı (OR): 6.302 (1,856-21,394); p=0,003] ve sekonder enfeksiyon [OR: 3,334 (1,313-8,496); p=0,011] için bağımsız belirleyiciydi.

Sonuç: Sistemik kortikosteroid kullanan ve kullanmayan hastaların karşılaştırılması sonucunda, kritik hastalığı olan COVID-19 hastalarında yüksek kümülatif doz advers olaylarla ilişkili olabilir.

Anahtar Kelimeler: Deksametazon, metilprednizolon, yoğun bakım, koronavirüs, SARS-CoV-2

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