Does methylprednisolone affect time to recovery in COVID–19 Pneumonia?
Objective: Current literature has conflicting results on the role of steroids in the treatment of coronavirus disease 2019 (COVID-19) pneumonia. This study aims to evaluate the effects of steroids on clinical recovery, duration of hospitalization, and time needed for the cessation of oxygen treatment. Patients and Methods: We retrospectively analyzed the medical records of patients hospitalized for COVID-19 between March and May 2020. Patient age, laboratory parameters, clinical stages, radiologic scores, length of hospital stay, and time needed for the cessation of oxygen supplementation were compared. Results: Thirteen patients were treated with steroids, and 12 controls were included in the analysis. Regarding the laboratory parameters, the groups were similar except for lymphocyte percentage (9.8 ± 3.2, 7.0 ± 2.9; p=0.033), which was higher, and D-dimer levels (0.75 (0.60-1.43), 1.57 (0.91-2.29); p=0.047), which were lower in the steroid group on admission. Steroid treatment provided a tendency of decrease in time to cessation of oxygen supplementation (6.23 ± 3.4 vs 7.67 ± 2.1, p=0.217). Conclusion: Although, systemic steroids, started in the subacute period, did not affect the length of hospital stay, they provided a tendency of decrease in the time until the cessation of oxygen supplementation in the subacute period.
___
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for
mortality of adult inpatients with COVID-19 in Wuhan, China:
a retrospective cohort study. Lancet 2020;395(10229):1054-62.
doi: 10.1016/S0140-6736(20)30566-3
- Cheng ZJ, Shan J. 2019 Novel coronavirus: where we are
and what we know. Infection 2020;48:155-63. doi: 10.1007/
s15010.020.01401-y
- Novel Coronavirus Pneumonia Emergency Response
Epidemiology Team – The Epidemiological Characteristics
of an Outbreak of 2019 Novel Coronavirus Diseases
(COVID-19) Available at: http://weekly.chinacdc.cn/en/
article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51. Accessed:
08.01.2021
- Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19
associated with acute respiratory distress syndrome. The
Lancet Respiratory Medicine 2020;8:420-2. doi: 10.1016/
S2213-2600(20)30076-X
- Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S,
Chiumello D. COVID-19 does not lead to a “Typical” acute
respiratory distress syndrome. Am J Respir Crit Care Med
2020;201:1299-300. doi: 10.1164/rccm.202.003.0817LE
- Klok FA, Kruip M, van der Meer NJM, et al. Confirmation
of the high cumulative incidence of thrombotic complications
in critically ill ICU patients with COVID-19: An updated
analysis. Thromb Res 2020;191:148-50. doi: 10.1016/j.
thromres.2020.04.041
- Mehta N, Mazer-Amirshahi M, Alkindi N, Pourmand A.
Pharmacotherapy in COVID-19; A narrative review for
emergency providers. Am J Emerg Med 2020;38:1488-93. doi:
10.1016/j.ajem.2020.04.035
- Jiang S, Liu T, Hu Y, et al. Efficacy and safety of glucocorticoids
in the treatment of severe community-acquired pneumonia:
A meta-analysis. Medicine 2019;98:e16239. doi: 10.1097/
MD.000.000.0000016239
- Arabi YM, Mandourah Y, Al-Hameed F, et al. Corticosteroid
therapy for critically ill patients with middle east respiratory
syndrome. Am J Respir Crit Care Med 2018;197:757-67. doi:
10.1164/rccm.201.706.1172OC
- Stockman LJ, Bellamy R, Garner P. SARS: systematic review of
treatment effects. PLoS Medicine 2006;3:e343. doi: 10.1371/
journal.pmed.0030343
- Moreno G, Rodriguez A, Reyes LF, et al. Corticosteroid
treatment in critically ill patients with severe influenza
pneumonia: a propensity score matching study. Intensive Care
Med 2018;44:1470-82. doi: 10.1007/s00134.018.5332-4
- Marik PE. Steroids for sepsis: yes, no or maybe. J Thorac Dis
2018;10(Suppl 9):S1070-S3. doi: 10.21037/jtd.2018.04.35
- Biffl WL, Moore FA, Moore EE, Haenel JB, McIntyre RC, Jr.,
Burch JM. Are corticosteroids salvage therapy for refractory
acute respiratory distress syndrome? Am J Surg 1995;170:591-
5; discussion 5-6. doi: 10.1016/s0002-9610(99)80022-1
- Zhou W, Liu Y, Tian D, et al. Potential benefits of precise
corticosteroids therapy for severe 2019-nCoV pneumonia.
Signal Transduct Target Ther 2020;5:18. doi: 10.1038/
s41392.020.0127-9
- RECOVERY Collaborative Group, Horby P, Lim WS,
Emberson JR, et al. Dexamethasone in hospitalized
patients with Covid-19 – Preliminary report. N Engl J Med
2021;384:963-704. doi: 10.1056/NEJMoa2021436
- Republic of Turkey, Ministry of Health April 14th 2020
Available at: https://covid19bilgi.saglik.gov.tr/tr/covid-19-
rehberi.html. Accessed 23.12.2020
- WHO Working Group on the Clinical Characterisation
Management of COVID infection. A minimal common
outcome measure set for COVID-19 clinical research. The
Lancet Infect Dis 2020;20:e192-e7. doi: 10.1016/S1473-
3099(20)30483-7
- Siddiqi HK, Mehra MR. COVID-19 illness in native and
immunosuppressed states: A clinical-therapeutic staging
proposal. J Heart Lung Transplant 2020;39:405-7. doi:
10.1016/j.healun.2020.03.012
- Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation
and clinical classification of coronavirus disease (COVID-19).
Eur Radiol 2020;30:4407-16. doi: 10.1007/s00330.020.06817-6
- Mehta P, McAuley DF, Brown M, et al. COVID-19: consider
cytokine storm syndromes and immunosuppression.
Lancet 2020;395(10229):1033-4. doi: 10.1016/S0140-
6736(20)30628-0
- Lee N, Allen Chan KC, Hui DS, et al. Effects of early
corticosteroid treatment on plasma SARS-associated
Coronavirus RNA concentrations in adult patients. J Clin
Virol 2004;31:304-9. doi: 10.1016/j.jcv.2004.07.006
- Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, Lim WS.
Corticosteroids as adjunctive therapy in the treatment of
influenza. The Cochrane Database of Systematic Reviews
2016;3:CD010406. doi: 10.1002/14651858.CD010406.pub2
- Chen RC, Tang XP, Tan SY, et al. Treatment of severe acute
respiratory syndrome with glucosteroids: the Guangzhou
experience. Chest 2006;129:1441-52. doi: 10.1378/
chest.129.6.1441
- Ye Z, Wang Y, Colunga-Lozano LE, et al. Efficacy and
safety of corticosteroids in COVID-19 based on evidence
for COVID-19, other coronavirus infections, influenza,
community-acquired pneumonia and acute respiratory distress
syndrome: a systematic review and meta-analysis. CMAJ (
Canadian Medical Association Journal) 2020;192:E756-67.
doi: 10.1503/cmaj.200645
- Wu C, Chen X, Cai Y, et al. Risk factors associated with
acute respiratory distress syndrome and death in patients
with coronavirus disease 2019 pneumonia in Wuhan,
China. JAMA Intern Med 2020;180:934-43. doi: 10.1001/
jamainternmed.2020.0994
- WHO Rapid Evidence Appraisal for COVID-19
Therapies Working Group, Sterne JAC, Murthy S, Diaz
JV, et al. Association Between Administration of Systemic
Corticosteroids and Mortality Among Critically Ill Patients
With COVID-19: A Meta-analysis. JAMA 2020;324:1330-41.
doi: 10.1001/jama.2020.17023
- Ruiz-Irastorza G, Pijoan JI, Bereciartua E, Dunder S,
Dominguez J, Garcia-Escudero P, et al. Second week methylprednisolone
pulses improve prognosis in patients with severe
coronavirus disease 2019 pneumonia: An observational
comparative study using routine care data. PLoS One
2020;15:e0239401. doi: 10.1371/journal.pone.0239401
- Wang Y, Jiang W, He Q, Wang C, Wang B, Zhou P, et al.
Early, low-dose and short-term application of corticosteroid
treatment in patients with severe COVID-19 pneumonia:
single-center experience from Wuhan, China. medRxiv.
2020:2020.03.06.20032342. doi: 10.1101/2020.03.06.20032342
- WHO Living Guidance. Corticosteroids for COVID-19 2020
Available at :https://apps.who.int/iris/rest/bitstreams/1299344/
retrieve. Accessed: 17.12.2020
- Yang Z, Liu J, Zhou Y, Zhao X, Zhao Q, Liu J. The effect
of corticosteroid treatment on patients with coronavirus
infection: a systematic review and meta-analysis. J Infect
2020;81:e13-e20. doi: 10.1016/j.jinf.2020.03.062
- Li H, Chen C, Hu F, et al. Impact of corticosteroid
therapy on outcomes of persons with SARS-CoV-2,
SARS-CoV, or MERS-CoV infection: a systematic review
and meta-analysis. Leukemia 2020;34:1503-11. doi:
10.1038/s41375.020.0848-3
- Sarkar S, Khanna P, Soni KD. Are the steroids a blanket
solution for COVID-19? A systematic review and metaanalysis.
J Med Virol 2021;93:1538-47. doi: 10.1002/jmv.26483
- Jeronimo CMP, Farias MEL, Val FFA, et al. Methylprednisolone
as adjunctive therapy for patients hospitalized with COVID-19
(Metcovid): A randomised, double-blind, phase iib, placebocontrolled
trial. Clin Infect Dis 2021;72:e373-e81. doi:
10.1093/cid/ciaa1177
- Copin MC, Parmentier E, Duburcq T, et al. Time to consider
histologic pattern of lung injury to treat critically ill patients
with COVID-19 infection. Intensive Care Med 2020;46:1124-
6. doi: 10.1007/s00134.020.06057-8
- Kory P, Kanne JP. SARS-CoV-2 organising pneumonia: ‘Has
there been a widespread failure to identify and treat this
prevalent condition in COVID-19?’. BMJ Open Respir Res
2020;7:e000724. doi: 10.1136/bmjresp-2020-000724