A Study On Application Value Of Glucocorticoids In The Treatment Of SARS

Objective To explore the value of using glucocorticoids(GCS) in the treatment of SARS.Methods The all SARS cases in 2002~2004 in China who fulfilled the criteria were grouped in two groups, using GCS group and not using group; evaluate the value of GCS in treatment of SARS by analyzing if GCS can improve the symptoms of patients, reduce the mortality of patients, shorten the length of stay and increase the risk of complication. Statistical methods include Chi-square test, Wilcoxon rank test, trend test, Logistic regression and Cox regression.Results 1. GCS do improve the symptoms of SARS patients. Chest and respiratory symptoms of using GCS group have been improved after treatment, and the results are significant (P<0.0001). But GCS may not shorten the fever time. 2. GCS can not lower the mortality. The results of unifactor logistic regression show that the risk of mortality of using GCS group is as 3.686 times as not using group, P<0.0001. Multifactor logistic regression results show that GCS doesn't benefit to outcome after controlling the impact of age, patient's condition, and other disease,stratified by pathogenetic condition. The total GCS dose is the risk factor of mortality to common type patients and the risk of mortality increases 0.777 times when it increases one grade; the daily average dose of GCS is the risk factor of mortality to all patients and the risk of mortality increases 1.623 and 1.854 times to common type patients and serious type patients respectively when it increases one grade. 3. GCS can not shorten the length of stay. The results of unifactor Cox regression show that the discharge hazard ratio of using GCS group is as 0.331 times as not using group, P<0.0001. Stratified by region, time, and other disease, multifactor Cox regression results show that discharge hazard ratio reduces to 0.642, 0.664, 0.665 times, P<0.0001, when total GCS dose increases one grade, after controlling other factors such as age. 4. GCS may improve complications to happen. There are significant differences in happening total complications and each single complication between two groups, except tuberculosis and sudden death. Multifactor logistic regression results show that the total GCS dose is the risk factor of complications happening after controlling the impact of age, patient's condition, and other disease,stratified by pathogenetic condition. The risk increases 0.821 and 0.263 times in common type patients and serious type patients respectively when the total GCS dose increases one grade.Conclusion GCS therapy can improve the symptoms of SARS patient and gain time to rescue patients for clinicians, but it doesn't benefit to outcome and can't shorten the length of stay and it can cause adverse reaction. In order to play a positive role in reducing the incidence of side effects and avoid adverse outcome, we should strictly follow the indications of GCS using.