A retrospective cohort study of methylprednisolone therapy in severe patients with COVID-19 pneumonia

Abstract

, in Wuhan, China. There are over 1,800,000 confirmed cases worldwide. 1 The pathological process of severe COVID-19 pneumonia is an inflammation reaction characterized by the destruction of the deep airway and alveolar. 2 It is currently considered that lung injury is not only associated with the direct virus-induced damage, but also the immune responses triggered by COVID-19 that lead to the activation of immune cells to release a large number of pro-and anti-inflammatory cytokines. Histologic examination has shown diffuse alveolar damage and mucinous exudate, which is similar to acute respiratory distress syndrome. 2 Aggravation of symptoms always occurs during 5-7 days after onset in patients with COVID-19 pneumonia and severe cases develop rapidly to acute respiratory failure. 3 Therefore, it is important to strengthen the treatment to suppress the proinflammatory response and control the cytokine storm at this stage. Methylprednisolone are the classical immunosuppressive drugs, which are important to stop or delay the progress of the pneumonia, and have been proved to be effective for the treatment of acute respiratory distress syndrome (ARDS). In a recent study, Wu et al. 4 found the administration of methylprednisolone appeared to reduce the risk of death in COVID-19 pneumonia patients with ARDS, however, of those who received methylprednisolone treatment, 23 of 50 patients died. This is a rather high mortality rate of~50%; therefore, in terms of the indication, timing, dosage and duration, the application of methylprednisolone warrants further investigation. In another study, Zhou et al. 5 endorsed the potential benefits of low-dose corticosteroids treatment in a subset of critically ill patients with COVID-19 pneumonia, however, the data was limited to only 15 patients and no control group. Although this is an important issue with regard to the challenges in the treatment of severe COVID-19 pneumonia, the clinical applicability of methylprednisolone needs to be tempered owing to the unanswered questions that remain. To address this issue, we performed a retrospective cohort study comparing the clinical outcomes of COVID-19 pneumonia patients with or without methylprednisolone treatment. We studied 46 severe patients with COVID-19 pneumonia at the

Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

“…[33] Fernandez-Cruz et al reported lower mortality in patients with COVID-19 pneumonia complicated with ARDS and/or a hyperin ammatory syndrome treated with corticosteroids (HR 0.36, 95% CI 0.14 to 0.93, p=0.04). [46] In the other four studies, no signi cant difference in mortality rates between steroid and non-steroid groups, [36,40,48] or even an increased risk in the group that received corticosteroids was demonstrated. [50] However, Lu et al did note that every increase of 10 mg in hydrocortisone equivalent dosage was associated with a 4% elevation of the mortality risk (HR 1.04, 95% CI 1.01-1.07).…”

“…[42,43] In the remaining eight studies, the risk of corticosteroid use was quanti ed, and these were included to calculate the pooled estimate. [23,33,36,37,40,46,48,50] The overall pooled estimate (observational studies and the RCT) showed a favorable outcome in the corticosteroid group (relative risks RR 0.55, 95% CI 0.27-0.83, random effects) ( Figure 2).…”

“…The indication for corticosteroids was reported in 7/22 studies and varied: most frequently it comprised (a combination of) worsening oxygenation, severe radiological ndings, ICU admission, or persistence of in ammatory symptoms. [33,[38][39][40][41][42][43] The median time of initiation after admission was reported in 8/22 studies and varied from 24 hours after hospital admission, [44] immediately after ICU admission [43] to approximately eight to fourteen days after onset of symptoms. [23,41,42,[45][46][47] One study compared early (average 2 days after hospital admission) to late corticosteroid administration (average 5 days after hospital admission).…”

“…[33] Methylprednisolone was the most frequently used corticosteroid (13/22 studies). [33,[37][38][39][40][42][43][44]46,[48][49][50][51] In two studies methylprednisolone, hydrocortisone, or dexamethasone was used. [36,41] Ling et al used prednisolone or dexamethasone, [52] and Horby et al reported on dexamethasone use.…”

“…In most studies a low dose methylprednisolone was administered, ranging from 0.5 to 2 mg/kg body weight per 24 hours. [33,38,40,42 Mortality (see also Table 2) Fourteen studies reported mortality, including in-hospital and 28-day mortality. In four of these, mortality was only described in the overall study population and not speci ed for steroid or non-steroid study groups.…”