AĞIR COVID-19 PNÖMONİSİNDE PULSE STEROİD TEDAVİSİNİN MORTALİTE ÜZERİNE ETKİSİ

COVID-19 hastalığının süreci esnasında ortaya çıkan hiperinflamatuar fazda kullanılan pulse steroid tedavisinin hastaların inflamatuar belirteçlerine ve klinik durumlarına etkisini gözlemlemeyi amaçladık. Gereç ve Yöntem Bu çalışmada hiperinflamatuar faz nedeniyle pulse steroid (yüksek doz metilprednizolon) ile tedavi edilen, COVID-19 PCR (polimeraz zincir reaksiyonu) testi pozitif olan 30 hasta değerlendirildi. Hastaların klinik durumları ve inflamatuar belirteçleri retrospektif olarak incelendi. Hastalar; yaş, cinsiyet, entübasyon durumu, klinik düzelme, taburculuk, mortalite oranı, tedavi başlangıcından 24-48-72. saat ve 7. günde ölçülen; C-reaktif protein (CRP), prokalsitonin, ferritin, oksijen saturasyon değeri ve lenfosit sayısı açısından değerlendirildi. Bulgular Toplamda pulse steroid tedavisi alan 21 erkek, 9 kadın olmak üzere 30 hasta incelendi. Ortanca yaş 66 [31-88] olarak hesaplandı. Çalışmada 15 (%50) hasta vefat etmiş olup, bunun 11’i erkek, 4’ü kadın hastaydı. Yaşayan ve ölen hastalar karşılaştırıldıklarında; pulse steroid tedavisi sonrası 72. saat ve 7. günde ölçülen ferritin, CRP, prokalsitonin değerlerinin yaşayan hasta grubunda anlamlı olarak azaldığı görüldü. (sırasıyla 72. saat p= 0,01; 0,08 ; <0,05) (sırasıyla 7. gün p = 0,01; 0,07 ; <0,05) Sonuç Pulse steroid tedavisi sonrası ferritin, CRP gibi inflamatuar belirteçlerin anlamlı olarak azalması ve bu azalmanın yaşayan hasta grubunda daha belirgin olması, steroidlerin hiperinflamatuar süreçlerde kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler:

COVİD-19, pulse steroid tedavisi, CRP, ferritin

EFFECT OF PULSE STEROID THERAPY ON MORTALITY IN SEVERE COVID-19 PNEUMONIA

Objective We aimed to observe the effect of pulse steroid therapy used in the hyperinflammatory phase that occurs during the course of the COVID-19 disease on the inflammatory markers and clinical conditions of the patients. Materials and Methods In this study, 30 patients with positive COVID-19 PCR (polymerase chain reaction) test who were treated with pulse steroid (high-dose methylprednisolone) due to the hyperinflammatory phase were evaluated. The clinical conditions and inflammatory markers of the patients were retrospectively analyzed. Patients were evaluated in terms of age, gender, intubation status, clinical improvement, discharge, mortality rate, 24th, 48th, 72nd hours and 7th days after treatment initiation, C-reactive protein (CRP), procalcitonin, ferritin, oxygen saturation values, lymphocyte count. Results A total of 30 patients; 21 male and 9 female, who received pulse steroid therapy were examined. The median age was calculated as 66 [31-88]. In the study, 15 (50%) patients died, of which 11 were male and 4 were female. When the survived and deceased patients were compared, it was observed that the values of ferritin, CRP procalcitonin measured at 72 hours and 7 days after pulse steroid treatment decreased significantly in the survived patient group. (72nd hour p-values=0.01-0.08- <0.05, respectively) (7th day p-value=0.01-0.07-<0.05, respectively) Conclusion The significant decrease in inflammatory markers such as ferritin and CRP after pulse steroid therapy and the fact that this decrease is more obvious in the survived patient group suggests that steroids can be used in hyperinflammatory processes.

Keywords:

COVID-19, pulse steroid therapy, CRP, ferritin,

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