Clinical characteristics and corticosteroids application of different clinical types in patients with corona virus disease 2019

Abstract

To describe the epidemiological and clinical characteristics of patients with Corona Virus Disease 2019 (COVID-19) in Beijing. To analyze the application of corticosteroids in patients with severe pneumonia. We collected information on demographic characteristics, exposure history, clinical characteristics, corticosteroids use, and outcomes of the 65 confirmed cases of COVID-19 at Fifth Medical Center of PLA General Hospital from Jan 20 to Feb 23, 2020. The final follow-up date observed was April 15th, 2020. The number of patients with mild, general, severe, and critical type were 10 (15.38%), 32 (49.23%), 8 (12.31%), and 15 (23.08%), respectively. The median incubation period was 6 days. Notable outliers were 1 patient at 16 days and 1 patient at 21 days. In lymphocyte subgroup analysis, decreases in total, T, CD4, and CD8 lymphocytes were more common as the disease worsened (All P < 0.05). Methylprednisolone (mPSL) was applied to 31 (47.69%) patients with pneumonia, including 10 (31.25%) general, 8 (100%) severe, and 13 (86.67%) critical patients, respectively. Corticosteroids inhibited Interleukin-6(IL-6) production (P = 0.0215) but did not affect T lymphocyte (P = 0.0796). There was no significant difference between patients using lower dose (≤ 2 mg/kg day) and higher dose (> 2 mg/kg day) mPSL in inhibiting IL-6 production (P = 0.5856). Thirty of 31 patients (96.77%) had stopped mPSL due to improvement of pneumonia. Virus RNA clearance time lengthened with disease progression (P = 0.0001). In general type, there was no significant difference in virus clearance time between patients with (15, 12-19 days) and without (14.5, 11-18 days) (P = 0.7372) mPSL use. Lymphocyte, especially T lymphocyte, in severe and critical patients showed a dramatic decrease. Application of lower dose corticosteroids (≤ 2 mg/kg day) could inhibit IL-6 production (a representative of cytokines) as effectively as a higher dose. Proper use corticosteroids in general type patients did not delay virus clearance. In December 2019, cases of acute respiratory disease (ARD), now known as a Corona Virus Disease 2019 (COVID-19) occurred in Wuhan, Hubei Province, China 1-3. Presently, the laboratory-confirmed cases and recorded deaths in the world are still increasing at an alarming rate 4-10. COVID-19 clinical types were defined according to the Diagnosis and Treatment of Pneumonia caused by Novel Coronavirus (Version 6 Trial) published on the website of the Central Government of the People's Republic of China 11. There are four distinct clinical types based on the severity of the disease. However, the differences in clinical characteristics, corticosteroids application, and outcomes among different clinical types have not been reported.

The Role of Glucocorticoids in the Management of COVID-19

“…Based on the known and extensive immunosuppressive effects of glucocorticoids outlined above, corticosteroid treatment likely attenuates the COVID-19 induced inflammatory response – particularly in severely affected patients. Indeed, administration of glucocorticoids was reported to reduce CRP and IL-6 plasma levels in COVID-19 patients, without affecting virus clearance 58 59 . Future studies identifying glucocorticoid target cells and anti-inflammatory mechanisms in the context of COVID-19 are critical in order enable the development of targeted therapies in the future.…”

High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response

“…It is worth nothing that in this study we define high dose corticosteroids pulses as doses of at least 125 mg of methylprednisolone or dexamethasone equivalent. Previous studies in COVID-19 patients did not found clinical differences between methylprednisolone doses above 125 mg [ 14 , 25 , 26 ]. We also tested for low corticosteroid doses and did not find a statistically significant difference in outcome.…”

“…Other studies have shown that corticosteroid therapy does not affect virus clearance time [ 38 ]. Unfortunately, in our study we did not carry out a follow up quantify viral clearance.…”

Insights into forsythia honeysuckle (Lianhuaqingwen) capsules: A Chinese herbal medicine repurposed for COVID-19 pandemic

“…As part of the anti-inflammatory mechanisms, compound 12 in LH capsules can inhibit the inflammatory cytokine storm by inhibiting the phosphorylation of JAK1/2, which is downstream of IL-6( Billing et al, 2019 ). IL-6 can be used as a biomarker of the severity and prognosis related to cytokine storms( Del Valle et al, 2020 ; Guo et al, 2020 ; Liu et al, 2020a ), and its expression is higher than those of TNF-α and IL-1. High concentrations of IL-6 can induce various pathological functions related to thrombosis, vascular leakage and myocardial dysfunction, and these effects lead to tissue hypoxia, hypotension, multiple organ dysfunction, and diffuse intravascular coagulation.…”

“…Unfortunately, there is currently no vaccine or antiviral treatment for patients with suspected or confirmed COVID-19( Amin and Jha, 2020 ; Kouznetsov, 2020 ; Shang et al, 2020 ; Shi et al, 2020 ). The drugs that are clinically used include remdesivir, abidol, and RNA synthesis hormones( Chu et al, 2004 ; Liu et al, 2020a ; Lu, 2020 ; Zheng et al, 2020 ), but the efficacy and safety of these drugs still need further clinical confirmation. With respect to vaccines, 30 vaccine candidates have been reported to the WHO and are in the clinical phase, but only six vaccines have entered the III clinical phase as of August 20, 2020( Florindo et al, 2020 ).…”