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

Year 2021, Volume: 34 Issue: 2, 120 - 126, 31.05.2021

Derya Kocakaya Şehnaz Olgun Yıldızelı Baran Balcan Emel Eryuksel Sait Karakurt

https://doi.org/10.5472/marumj.942800

Cited By: 1

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.

Keywords

COVID-19, Steroids, Length of stay

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