Outcomes of patients with COVID-19 pneumonia treated with moderate and high dose corticosteroids

Year 2022, , 273 - 278, 26.07.2022

Şeyma Başlılar , Bengü Şaylan

https://doi.org/10.38053/acmj.1099212

Abstract

Introduction: The mortality related to coronavirus disease-2019 (COVID-19) develops due to hyper immune response in most of the patients. The use of corticosteroids (CS) is reported to be effective in decreasing mortality and maintaining a better prognosis but the results of some studies are against the use of CS due to delayed virus clearing, adverse effects, and insignificant effect on clinical course and outcome. We aimed to evaluate the effect of CS use in hospitalized COVID-19 pneumonia patients on clinical course and mortality.
Material and Method: Demographic and laboratory data, history for CS treatment, need for oxygen support, duration of hospitalization and/or ICU follow up, and mortality of inpatients with COVID-19 pneumonia treated between 15.03.2020 and 15.06.2021 at Sultan 2. Abdülhamid Han Training and Research Hospital were collected. The whole cases were divided into two groups as CS group (who were given CS) and the control group (who did not receive CS). All parameters were compared between the two groups.
Results: A total of 185 patients (122 CS group and, 63 control group) were included in the study. The patients in the CS group were younger than the controls (median age was 63 (30-91) years and 71 (34-91) years respectively, p<0.001). In the CS group compared to controls, the number of cases followed in ICU and intubated was lower (55 [45.1%] cases vs. 53 [84.1%] cases, p<0.001 and 40 [32.8%] cases vs. 53 [84.1%] cases, p<0.001, respectively) but, the time for ICU and hospital stay was longer (13 [1-32] days vs.6 [1-29] days, p<0.001 and 11 [5-44] days vs. 9 [4-35]days, p=0.005, respectively). The number of cases who died was less in the CS group compared to controls significantly (35 [28.7%] cases vs. 53 [84.1%] cases respectively, p<0.001).
Conclusion: CS treatment may be related to better prognosis and less mortality in COVID-19 pneumonia inpatients although it may prolong the time for ICU follow up and hospitalization.

Keywords

COVID-19, pneumonia, corticosteroid, mortality

References

• Hojyo S, Uchida M, Tanaka K, et al. How COVID-19 induces cytokine storm with high mortality. Inflamm Regen 2020; 40: 37.
• Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.
• Liu Z, Li X, Fan G, et al. Low-to-moderate dose corticosteroids treatment in hospitalized adults with COVID-19. Clin Microbiol Infect 2021; 27: 112-7
• Budhathoki P, Shrestha DB, Rawal E, et al. Corticosteroids in COVID-19: is it rational? a systematic review and meta-analysis. SN Compr Clin Med 2020: 1-21.
• Villar J, Confalonieri M, Pastores SM, et al. Rationale for prolonged corticosteroid treatment in the acute respiratory distress syndrome caused by coronavirus disease 2019. Crit Care Explor 2020; 2: e0111.
• Alijotas-Reig J, Esteve-Valverde E, Belizna C, et al. Immunomodulatory therapy for the management of severe COVID-19. Beyond the anti-viral therapy: a comprehensive review. Autoimmun Rev 2020; 19: 102569.
• 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 (Baltimore) 2019; 98: e16239.
• Singh AK, Majumdar S, Singh R, et al. Role of corticosteroid in the management of COVID-19: A systemic review and a Clinician’s perspective. Diabetes Metab Syndr 2020; 14: 971–8.
• Veronese N, Demurtas J, Yang L, et al. Use of corticosteroids in coronavirus disease 2019 pneumonia: a systematic review of the literature. Front Med (Lausanne) 2020; 7: 170.
• van Paassen J, Vos JS, Hoekstra EM, et al. Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes. Crit Care 2020; 24: 696.
• Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet 2020; 395: 473–5.
• Cogliati Dezza F, Oliva A, Cancelli F, et al. Determinants of prolonged viral RNA shedding in hospitalized patients with SARS-CoV-2 infection. Diagn Microbiol Infect Dis 2021; 100: 115347.
• 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
• Şahin Özdemirel T, Akkurt ES, Ertan Ö, Gökler ME, Akıncı Özyürek B. Complications with moderate-to-severe COVID-19 during hospital admissions in patients with pneumonia. J Health Sci Med 2021; 4: 766-771.
• Güngörer B. Baseline demographic, clinical and laboratory risk factors for predicting admission to intensive care unit in patients diagnosed with COVID-19 in the emergency department. Anatolian Curr Med J 2021; 3; 279-283.
• Öztürk Durmaz Ş, Sümer Coşkun A, Yalçın AN. Clinical and prognostic evaluation of patients admitted to the COVID-19 pandemic unit of the emergency department. J Health Sci Med 2021; 4: 835-839.
• Villar J, Ferrando C, Martínez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med 2020; 8: 267–76.