潜类分析显示，在患者资料中，与 COVID-19 相关的降钙素治疗比糖皮质激素治疗预后更好。

IF 2.7 2区生物学 Q3 BIOCHEMISTRY & MOLECULAR BIOLOGY

Journal of Steroid Biochemistry and Molecular Biology Pub Date : 2024-08-31 DOI:10.1016/j.jsbmb.2024.106609

Marta Entrenas-Castillo , Luis Manuel Entrenas-Costa , María P. Pata , Bernabe Jurado Gamez , Cristina Muñoz-Corroto , Cristina Gómez-Rebollo , Estefanía Mira-Padilla , Roger Bouillon , Jose Manuel Quesada-Gomez

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引用次数: 0

摘要

COVID-19肺炎的治疗已重新定位为降钙素和糖皮质激素，这两种药物可减轻病情严重程度，减少入住重症监护室的需要和死亡。目的：使用潜类聚类方法识别住院治疗的COVID-19肺炎患者的类别或特征，评估由此得出的患者特征的临床和预后相关性。预后差的定义是死亡或需要入住重症监护室，预后好的则相反。特别关注对降钙素的不同反应：地点：西班牙科尔多瓦索菲亚王后大学医院。患者 COVID-19 入院患者的回顾性观察队列研究。Clinicaltrials: gov 公共数据库（NCT05819918）：纳入标准：(i) 年龄≥ 18 岁且≤ 90 岁；(ii) 胸部 X 光片或 CT 扫描显示有浸润的肺炎；(iii) 已确诊感染 SARS-CoV-2；(iv) CURB Scale 65 >1：设计：潜类分析法，用于获得同质群组，不预先指定所属组别，并通过最小化信息标准选择最佳群组数量。通过卡方检验（chi-square）、费雪精确检验（Fisher's exact test）和 Kruskal-Wallis 检验（Kruskal-Wallis test）评估各变量在组间的差异：共纳入了 707 名从 2020 年 3 月 10 日至 2022 年 3 月 4 日住院的患者。在治疗变量方面，3级（60%的患者仅接受了钙化二醇治疗）与1级（82%的患者仅接受了低于1%的钙化二醇治疗，而82%的患者同时接受了两种治疗）、2级（82%的患者仅接受了低于1%的钙化二醇治疗，而82%的患者同时接受了两种治疗）和4级（84%的患者仅接受了1%的钙化二醇治疗，而84%的患者同时接受了两种治疗）之间存在差异。与仅接受糖皮质激素治疗的患者相比，3级患者（60%接受过钙泊三醇治疗）的预后明显更好（OR：15.2，95% CI：[3.73 - 142]，p结论：我们的实际研究表明，钙泊三醇治疗可显著减少因COVID-19肺炎住院的患者入住ICU的需求，并改善预后，尤其是在接受钙泊三醇治疗而不使用糖皮质激素的患者中。

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Latent Class Analysis Reveals, in patient profiles, COVID-19–related better prognosis by calcifediol treatment than glucocorticoids

Calcifediol and glucocorticoids have been repositioned for the treatment of COVID-19 and may reduce severity, the need for intensive care unit admission and death.

Objective

to identify class or profiles of patients hospitalized and treated with COVID-19 pneumonia using latent class clustering methods to assess the clinical and prognostic relevance of the resulting patients’ profiles. Poor prognosis was defined as death or need for ICU admission, good prognosis, the opposite. With special interest in differential responses to calcifediol.

Setting

Reina Sofia University Hospital, Córdoba Spain.

Patients

Retrospective observational cohort study of patients admitted for COVID-19. ClinicalTrials.gov public database (NCT05819918). Inclusion criteria: (i) Age ≥ 18 and ≤ 90 years, (ii) Pneumonia characterized by the presence of infiltrates on chest X-ray or CT scan, (iii) SARS-CoV-2 infection, confirmed, and (iv) CURB Scale 65 >1.

Design

Latent class analysis, for obtaining homogeneous clusters, without specifying a priori the belonging group, and selecting the optimal number of clusters by minimizing information criteria. Evaluating the differences between groups for each variable by means of chi-square, Fisher's exact test and Kruskal-Wallis test.

Results

707 patients hospitalized from 10 March 2020 until 4 March 2022 were included. For the treatment variable, differences were found between class 3 (60 % treated with calcifediol only) and classes 1 (less than 1 % calcifediol only vs. 82 % treated with both), 2 (less than 1 % calcifediol only vs. 82 % treated with both) and 4 (1 % calcifediol only vs. 84 % treated with both). Class 3, (60 % with calcifediol), had a significantly better prognosis compared to patients treated with glucocorticoids alone (OR: 15.2, 95 % CI: [3.73–142], p<0.001) or no treatment (OR: 7.38, 95 % CI: [2.63–30.2], p<0.001).

Conclusions

our real-life study shows that calcifediol treatment significantly reduces the need for ICU admission and improved prognosis in patients hospitalized for COVID-19 pneumonia, especially in the profile of patients receiving it without glucocorticoids.

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来源期刊

Journal of Steroid Biochemistry and Molecular Biology 生物-内分泌学与代谢

CiteScore

8.60

自引率

2.40%

发文量

113

审稿时长

46 days

期刊介绍： The Journal of Steroid Biochemistry and Molecular Biology is devoted to new experimental and theoretical developments in areas related to steroids including vitamin D, lipids and their metabolomics. The Journal publishes a variety of contributions, including original articles, general and focused reviews, and rapid communications (brief articles of particular interest and clear novelty). Selected cutting-edge topics will be addressed in Special Issues managed by Guest Editors. Special Issues will contain both commissioned reviews and original research papers to provide comprehensive coverage of specific topics, and all submissions will undergo rigorous peer-review prior to publication.