Ciddi COVID-19 pnömonisinde yüksek doz steroid tedavisinin akciğer fibrozisi üzerinde etkinlikleri

Abstract

Amaç: Yüksek doz kortikosteroidler pulmoner fibrozis gelişimini önleyebilir, ancak hangi kortikosteroid tedavisinin daha iyi olduğu bilinmemektedir. Bu araştırma, şiddetli koronavirüs hastalığı 2019 (COVID-19) pnömonisi olan hastalarda yüksek doz steroid tedavisinin (deksametazon veya metilprednizolon) uzun süreli akciğer fibrozu gelişimi üzerindeki etkilerini araştırmayı amaçlamıştır. Yöntemler: Yüksek doz steroid tedavisi alan ağır pnömonili COVID-19 hastaları iki gruba ayrıldı: metilprednizolon alanlar ve deksametazon alanlar. Her iki grubun solunum, karaciğer ve böbrek fonksiyonları, enflamatuar belirteçler, ferritin, C-reaktif protein (CRP), prokalsitonin, hematolojik testler, kan şekeri seviyeleri, entübasyon durumu, klinik iyileşme, taburcu oranları ve mortalite oranları gibi çeşitli parametreleri ölçüldü ve karşılaştırıldı. Bulgular: İki grupun hastalarının kan parametreleri farklıydı. Deksametazon hastalarında açlık kan şekeri (FBG), kreatinin, aspartat transaminaz (AST), alanin transaminaz (ALT), laktat dehidrojenaz (LDH), D-Dimer ve CRP daha yüksekken, metilprednizolon hastalarında daha düşük ALT, beyaz kan hücreleri (WBC), nötrofiller, lenfositler ve trombositler görüldü. Hastaneye yatış ve tomografi sonuçlarında iyileşme görüldü. Metilprednizolon hastalarının %70,8'i iyileşme gösterirken, deksametazon hastalarının %58,5'i iyileşme gösterdi. Fark anlamlı değildi. Sonuç: Kortikosteroidler ağır ciddi COVID-19 hastalarında mortaliteyi azaltmaktadır. Bu çalışmanın sonuçlarına göre, metilprednizolon laboratuvar parametreleri üzerinde daha olumlu bir profil sağlamış ve böylece pulmoner arter hastalığı gelişiminde biraz daha iyi bir iyileşme göstermiştir.

Keywords

• Pulmoner Fibrozis
• COVID-19 Pnömonisi
• Metilprednizolon
• Deksametazon

Supporting Institution

yok

Ethical Statement

Kurumumuz etik kurulundan 7 Şubat 2023 tarihinde, 2228 protokol numarasıyla onay alınmıştır. Tüm katılımcılardan bilgilendirilmiş onam formu alınmıştır.

Effectiveness of high-dose steroid treatment on pulmonary fibrosis in severe COVID-19 pneumonia

Abstract

Aims: Corticosteroid therapy has been proposed as a therapeutic strategy to mitigate pulmonary inflammation and fibrosis in severe COVID-19 pneumonia. This study aimed to evaluate the effects of high-dose methylprednisolone (MP) and dexamethasone (DEX) on clinical and radiological outcomes. Methods: In this retrospective study, hospitalized patients with severe COVID-19 pneumonia were categorized into three groups: MP, DEX, and control. Demographic, clinical, and laboratory data were analyzed, and radiological outcomes were assessed using baseline and follow-up chest computed tomography (CT) scans. Univariate and multivariate logistic regression analyses were performed to identify factors associated with radiological improvement. Results: Age and sex distributions differed among groups, and the control group consisted of older and predominantly male participants. Steroid-treated groups had longer hospital and intensive care unit (ICU) stays, while mechanical ventilation rates were similar across groups. Laboratory parameters including levels of glucose, creatinine, alanine transferase (ALT), aspartate transferase (AST), lactate dehydrogenase (LDH), D-dimer, and C-reactive protein (CRP) differed significantly among groups. Baseline CT findings more frequently showed extensive and severe fibrosis in the control group, whereas moderate involvement predominated in the DEX group. Follow-up CT scans revealed radiological improvements in at least two categories in 70.8% of MP, 58.5% of DEX, and 35.4% of control patients (p<0.001). Multivariate analysis demonstrated that both MP (OR=11.11; p<0.001) and DEX (OR=9.49; p<0.001) treatments, as well as baseline CT severity, were independent predictors of radiological improvement. Age, ICU admission, and mechanical ventilation were not significantly associated with improvement. Conclusion: High-dose corticosteroid (CS) therapy, particularly MP, was associated with significantly greater radiological improvement in patients with severe COVID-19 pneumonia, independent of age, ICU admission, or use of mechanical ventilation. These findings suggest that CS may be effective in promoting pulmonary recovery and mitigating fibrotic progression in severe COVID-19 pneumonia.

Keywords

• COVID-19
• corticosteroids
• methylprednisolone
• dexamethasone
• pulmonary fibrosis
• chest CT
• radiological improvement
• severe pneumonia

Supporting Institution

none

Ethical Statement

Our institution approved the ethics committee on February 7th, 2023, with protocol number 2228. Informed consent was obtained from all participants.

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