Corticosteroids, COVID-19 pneumonia, and acute respiratory distress syndrome

被引:39
|
作者
Matthay, Michael A. [1 ,2 ,3 ]
Wick, Katherine D. [1 ,3 ]
机构
[1] UCSF, Cardiovasc Res Inst, San Francisco, CA USA
[2] UCSF, Dept Med, San Francisco, CA USA
[3] UCSF, Dept Anesthesia, San Francisco, CA USA
来源
JOURNAL OF CLINICAL INVESTIGATION | 2020年 / 130卷 / 12期
关键词
THERAPY; CELLS; SARS;
D O I
10.1172/JCI143331
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Although corticosteroids dampen the dysregulated immune system and sometimes are prescribed as an adjunctive treatment for pneumonia, their effectiveness in the treatment of coronavirus disease 2019 (COVID-19) remains controversial. In this issue of the JCI, Liu and Zhang et al. evaluated corticosteroid treatment in more than 400 patients with severe COVID-19. The authors assessed subjects retrospectively for cardiac and liver injury, shock, ventilation, mortality, and viral clearance. Corticosteroids in severe COVID-19-related acute respiratory distress syndrome (ARDS) were associated with increased mortality and delayed viral clearance. Here, we consider how to reconcile the negative effects of corticosteroids revealed by Liu and Zhang et al. with the favorable effects (reduced mortality) that were described in the RECOVERY trial. We posit that treatment timing, dosage, and COVID-19 severity determine immune response and viral outcome. Patients with moderate-to-severe COVID-19 pneumonia are likely to benefit from moderate-dose corticosteroid treatment when administered relatively late in the disease course.
引用
收藏
页码:6218 / 6221
页数:4
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