RESUMO
BACKGROUND: Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. METHODS: In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the final results of this assessment. RESULTS: A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.92 to 1.55). CONCLUSIONS: In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.).
Assuntos
Tratamento Farmacológico da COVID-19 , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Oxigenoterapia , Respiração Artificial , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/uso terapêutico , COVID-19/mortalidade , COVID-19/terapia , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Quimioterapia Combinada , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Hospitalização , Humanos , Injeções Intravenosas , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Razão de Chances , Reino UnidoAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Vírus da Hepatite B/fisiologia , Hepatite B Crônica/complicações , Falência Hepática Aguda/induzido quimicamente , Linfoma de Células B/tratamento farmacológico , Ativação Viral/efeitos dos fármacos , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Murinos , Antivirais/uso terapêutico , Ciclofosfamida/efeitos adversos , Doxorrubicina/efeitos adversos , Evolução Fatal , Feminino , Humanos , Lamivudina/uso terapêutico , Prednisona/efeitos adversos , Rituximab , Vincristina/efeitos adversosAssuntos
Anticoagulantes/efeitos adversos , Ponte Cardiopulmonar , Transplante de Coração , Hemofiltração , Heparina/efeitos adversos , Trombocitopenia/induzido quimicamente , Trombocitopenia/terapia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/cirurgia , Feminino , Insuficiência Cardíaca/etiologia , Hemofiltração/métodos , Hirudinas/efeitos adversos , Humanos , Pessoa de Meia-Idade , Proteínas Recombinantes/efeitos adversosRESUMO
Chronic myelomonocytic leukaemia is an atypical myeloproliferative disorder with a natural history of progression to acute myeloid leukaemia, a complex and poorly understood response by the bone marrow to stress. Cardiac surgery activates many inflammatory cascades and may precipitate a systemic inflammatory response syndrome. We present a case of undiagnosed chronic myelomonocytic leukaemia who developed rapidly fatal multi-organ dysfunction following cardiac surgery due to an acute leukaemoid reaction.
Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Reação Leucemoide/etiologia , Revascularização Miocárdica/efeitos adversos , Idoso , Doença da Artéria Coronariana/cirurgia , Evolução Fatal , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , MasculinoRESUMO
D-Dimer measurements are being increasingly used for negative prediction of deep vein thrombosis (DVT). At our institution, clinical score, D-Dimer assay, plethysmography and, if necessary, Doppler ultrasound are used to secure the diagnosis. We collected the data from 100 consecutive patients proven to have DVT. We examined their medical case notes at diagnosis for concurrent clinical conditions and one year later to look for documented evidence of malignancy. Twenty-two of the 66 patients with D-Dimers greater than 1000 ng/ml were diagnosed with a cancer compared with only 2 of the 34 patients with a presenting D-Dimer score of less than 1000 ng/ml. We propose that a D-Dimer score of less than 1000 ng/ml in proven DVT is a strong negative predictor for malignancy (p = 0.0025).