Sachin Ananth, Alexander G Mathioudakis, Jan Hansel
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引用次数: 0
摘要
关于类固醇在重症社区获得性肺炎(CAP)中的应用,目前存在相互矛盾的证据,以往的随机对照试验因样本量较小而受到限制。ESCAPe和CAPE COD是最近发表的两项关于类固醇治疗重症CAP的大型试验。ESCAPe对入院后72-96小时内开始使用甲基强的松龙进行了评估,而CAPE COD则对重症CAP发生后24小时内使用氢化可的松进行了研究。ESCAPe在全因60天死亡率或任何次要结果方面均未显示出任何差异。CAPE COD 显示,氢化可的松改善了 28 天内的全因死亡率,并降低了插管或血管加压休克的风险。两项试验之间的重要差异包括使用的类固醇方案、类固醇给药时间和基线特征,ESCAPe 纳入了更多的糖尿病患者。CAPE COD 的结果支持在发生严重 CAP 的 24 小时内开始使用氢化可的松,但还需要更多的研究来评估严重 CAP 的长期疗效和类固醇的最佳给药方案。
There is conflicting evidence regarding the use of steroids in severe community-acquired pneumonia (CAP), with previous randomised controlled trials limited by small sample sizes. ESCAPe and CAPE COD are two recently published large trials on steroids in severe CAP. ESCAPe assessed the initiation of methylprednisolone within 72-96 h of hospital admission, while CAPE COD studied the use of hydrocortisone within 24 h of the development of severe CAP. ESCAPe did not show any differences in all-cause 60-day mortality or any of its secondary outcomes. CAPE COD showed that hydrocortisone improved all-cause 28-day mortality and reduced the risk of intubation or vasopressor-dependent shock. Important differences between the trials included the steroid regimens used, timing of steroid administration and baseline characteristics, with more diabetic patients included in ESCAPe. The results of CAPE COD support the initiation of hydrocortisone within 24 h of developing severe CAP, but more research is needed to evaluate long-term outcomes and optimum dosing regimens for steroids in severe CAP.