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Does methylprednisolone affect time to recovery in COVID–19 Pneumonia?

Year 2021, , 120 - 126, 31.05.2021
https://doi.org/10.5472/marumj.942800

Abstract

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.

References

  • 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
Year 2021, , 120 - 126, 31.05.2021
https://doi.org/10.5472/marumj.942800

Abstract

References

  • 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
There are 35 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Derya Kocakaya This is me 0000-0003-2910-6813

Şehnaz Olgun Yıldızelı This is me 0000-0002-3236-3995

Baran Balcan This is me 0000-0003-1804-1970

Emel Eryuksel This is me 0000-0002-2194-8066

Sait Karakurt This is me 0000-0002-6699-5798

Publication Date May 31, 2021
Published in Issue Year 2021

Cite

APA Kocakaya, D., Olgun Yıldızelı, Ş., Balcan, B., Eryuksel, E., et al. (2021). Does methylprednisolone affect time to recovery in COVID–19 Pneumonia?. Marmara Medical Journal, 34(2), 120-126. https://doi.org/10.5472/marumj.942800
AMA Kocakaya D, Olgun Yıldızelı Ş, Balcan B, Eryuksel E, Karakurt S. Does methylprednisolone affect time to recovery in COVID–19 Pneumonia?. Marmara Med J. May 2021;34(2):120-126. doi:10.5472/marumj.942800
Chicago Kocakaya, Derya, Şehnaz Olgun Yıldızelı, Baran Balcan, Emel Eryuksel, and Sait Karakurt. “Does Methylprednisolone Affect Time to Recovery in COVID–19 Pneumonia?”. Marmara Medical Journal 34, no. 2 (May 2021): 120-26. https://doi.org/10.5472/marumj.942800.
EndNote Kocakaya D, Olgun Yıldızelı Ş, Balcan B, Eryuksel E, Karakurt S (May 1, 2021) Does methylprednisolone affect time to recovery in COVID–19 Pneumonia?. Marmara Medical Journal 34 2 120–126.
IEEE D. Kocakaya, Ş. Olgun Yıldızelı, B. Balcan, E. Eryuksel, and S. Karakurt, “Does methylprednisolone affect time to recovery in COVID–19 Pneumonia?”, Marmara Med J, vol. 34, no. 2, pp. 120–126, 2021, doi: 10.5472/marumj.942800.
ISNAD Kocakaya, Derya et al. “Does Methylprednisolone Affect Time to Recovery in COVID–19 Pneumonia?”. Marmara Medical Journal 34/2 (May 2021), 120-126. https://doi.org/10.5472/marumj.942800.
JAMA Kocakaya D, Olgun Yıldızelı Ş, Balcan B, Eryuksel E, Karakurt S. Does methylprednisolone affect time to recovery in COVID–19 Pneumonia?. Marmara Med J. 2021;34:120–126.
MLA Kocakaya, Derya et al. “Does Methylprednisolone Affect Time to Recovery in COVID–19 Pneumonia?”. Marmara Medical Journal, vol. 34, no. 2, 2021, pp. 120-6, doi:10.5472/marumj.942800.
Vancouver Kocakaya D, Olgun Yıldızelı Ş, Balcan B, Eryuksel E, Karakurt S. Does methylprednisolone affect time to recovery in COVID–19 Pneumonia?. Marmara Med J. 2021;34(2):120-6.