Objective: To investigate the effect of sivelestat sodium on survival, oxygenation index, and serum markers for infection in critically ill patients with COVID-19-associated acute respiratory distress syndrome (ARDS).
Methods: This retrospectively study was performed among the critically ill patients with COVID-19-associated ARDS admitted in the intensive care unit (ICU) at Nanfang Hospital, Southern Medical University. We collected the clinical data of the patients on the first day of ICU admission and on the day of discharge and laboratory tests results of interleukin-6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT) and oxygenation index on days 1, 3 and 7 following ICU admission. Propensity-score matching was used to match the patients receiving sivelestat sodium to those without the treatment. Cox proportional hazards model and linear regression analysis were used to assess the association of sivelestat sodium treatment with in-hospital mortality and the length of hospital stay.
Results: A total of 199 patients with COVID-19-associated ARDS patients were included for data analysis. After propensity-score matching PSM, 35 patients receiving sivelestat sodium were matched to 70 patients without the treatment. Treatment with of sivelestat sodium was not associated with the reduction of in- hospital mortality (P=0.36), prolonged ICU stay (P=0.39), hospital stay (P=0.68) or improved oxygenation index (P>0.05) of the patients. No significant difference was found in serum CRP or PCT levels between the patients with and without sivelestat sodium treatment, but a significant reduction in IL-6 level was found in sivelestat sodium group (P=0.016).
Conclusion: Sivelestat sodium treatment is not correlated with the reduction of mortality or length of hospital stay, but is associated with reduced serum IL-6 level in patients with COVID-19-associated ARDS.
目的: 探讨西维来司他钠治疗对COVID-19相关急性呼吸窘迫综合征（ARDS）重症患者的生存率、氧合指数和感染血清标志物的影响。
方法: 回顾性纳入南方医科大学南方医院重症医学科中诊断为COVID-19相关ARDS患者，从医疗系统收集其入ICU 24 h内以及出院当天的数据，并收集入ICU后第1、3、7天的CRP、PCT、IL-6和氧合指数值。采用倾向性评分匹配将接受西维来司他钠治疗的患者与未接受治疗的患者进行匹配。采用Cox回归分析与线性回归分析探讨西维来司他钠给药与院内死亡率以及住院时间之间的相关性。
结果: 研究纳入199名COVID-19相关ARDS重症患者。经过倾向性评分匹配，接受西维来司他钠治疗的35名患者和没有接受西维来司他钠治疗的70名患者进行了匹配。西维来司他钠治疗与院内死亡率的降低（P=0.36）、ICU住院时间的延长（P=0.39）、住院时间（P=0.68）以及氧合指数的改善（P>0.05）无关。C反应蛋白和降钙素原没有发现明显的差异，但在西维来司他钠治疗组发现IL-6水平明显降低（P=0.016）。
结论: 西维来司他钠与COVID-19相关ARDS重症患者的死亡率和住院时间的减少没有相关性，但与血清IL-6水平的降低有关。
Keywords: COVID-19; acute respiratory distress syndrome; interleukin-6; sivelestat sodium.