Corticosteroid use in COVID-19 pneumonia

Diken, Özlem Erçen; Yıldırım, Fatma; Gülhan, Pınar Yıldız; Özkaya, Şevket; Simsek, Meltem; Yücel, Cihan; Safçı, Sinem Berik; Deniz, Pelin Pınar; Çelik, Müge Coşkun; Akdağ, Devrim; Dirican, Adem

doi:10.5578/tt.20219811

Cited by 4 publications

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“…It has been suggested that early initiation of low‐dose methylprednisolone therapy (with up to 40 mg/day for <10 days) provides clinical, radiological improvement in patients with an active disease state of COVID‐19, by reducing the immune cascade and progression into cytokine without any adverse effect. 44 , 45 , 46 …”

Section: Discussionmentioning

confidence: 99%

The role of endotheliitis in COVID‐19: Real‐world experience of 11 190 patients and literature review for a pathophysiological map to clinical categorisation

et al. 2021

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Objective: COVID-19 may yield a variety of clinical pictures, differing from pneumonitis to Acute Respiratory Distress Syndrome along with vascular damage in the lung tissue, named endotheliitis. To date, no specific treatment strategy was approved for the prevention or treatment of COVID-19 in terms of endotheliitis-related comorbidities. Here, we presented our treatment strategies for 11 190 COVID-19 patients depending on categorisation by the severity of both the respiratory and vascular distress and presented the manifestations of endotheliitis in skin, lung and brain tissues according to the different phases of COVID-19.Methods: After a retrospective examination, patients were divided into three groups according to their repercussions of vascular distress, which were represented by radiological, histopathological and clinical findings. We presented the characteristics and courses of seven representative and complicated cases which demonstrate different phases of the disease and discussed the treatment strategies in each group.Results: Among 11 190 patients, 9294 patients met the criteria for Group A, and 1376 patients were presented to our clinics with Group B characteristics. Among these patients, 1896 individuals (Group B and Group C) were hospitalised. While 1220 inpatients were hospitalised within the first 10 days after the diagnosis, 676 of them were worsened and hospitalised 10 days after their diagnosis. Among hospitalised patients, 520 of them did not respond to group A and B treatments and developed hypoxemic respiratory failure (Group C) and 146 individuals needed ventilator support and were followed in the intensive care unit, and 43 (2.2%) patients died. Conclusion: Distinctive manifestations in each COVID-19 patient, including nonrespiratory conditions in the acute phase and the emerging risk of long-lasting complications, suggest that COVID-19 has endotheliitis-centred thrombo-inflammatory pathophysiology. Daily evaluation of clinical, laboratory and radiological findings of patients and deciding appropriate pathophysiological treatment would help to reduce the mortality rate of COVID-19.

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Section: Discussionmentioning

confidence: 99%

The role of endotheliitis in COVID‐19: Real‐world experience of 11 190 patients and literature review for a pathophysiological map to clinical categorisation

et al. 2021

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“…Influenza A (H1N1) virus pneumonia is an interstitial pneumonia. [20] Most patients with influenza and IPA have no characteristic imaging changes in the early stage. [21] It is generally believed that abnormalities in chest imaging may be observed at 5 to 7 days after the onset of influenza.…”

Section: Discussionmentioning

confidence: 99%

“…Influenza A (H1N1) virus pneumonia is an interstitial pneumonia [20] . Most patients with influenza and IPA have no characteristic imaging changes in the early stage [21] .…”

Section: Discussionmentioning

confidence: 99%

Clinical study of invasive pulmonary aspergillosis following influenza A H1N1

Liu¹,

Xie²,

Wang³

et al. 2021

Medicine

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This study to analyze the clinical characteristics of patients with invasive pulmonary aspergillosis (IPA) following influenza A (H1N1) infection.We retrospectively analyzed 10 cases with IPA following H1N1 infection. The clinical manifestations, laboratory examination results, chest computed tomography, and treatments were analyzed.Clinical manifestations: all 10 cases had typical flu-like symptoms at the onset of the disease, among which 7 patients developed dyspnea in the late stage, and 8 patients had hemoptysis. Laboratory examination: the absolute and percentage of peripheral blood lymphocytes in all 10 patients were declined, among which 5 cases were with decreased CD3+ CD4+ T cells/lymphocytes; 9 cases with increased bronchoalveolar lavage fluid galactomannan; 6 cases with increased serum galactomannan; 1 case with bronchoalveolar lavage fluid cultured aspergillus fumigatus; and 2 cases with aspergillus by second-generation sequencing. Chest computed tomography: all patients showed multiple diffused ground-glass opacities at the beginning, along with linear or reticular interstitial changes. Two cases had multiple subarachnoid nodules with halo signs, 3 cases had consolidation in multiple segments of both lungs, 2 cases had cavities, and 4 cases were with pleural effusion. Treatment: 10 patients were treated with antiviral and anti-Aspergillus drugs after admission. Four patients received respiratory support. All 10 cases were cured and discharged.Early diagnosis of IPA in influenza A (H1N1) patients is the key to successful treatment.

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“…Worldwide, more than 112 million cases of coronavirus and 3.8 million deaths have been reported (1). Nowadays only glucocorticoids are known to decrease mortality rates among severe coronavirus disease 2019 (COVID-19) infections (2,3). The corticosteroids' mechanism in critically ill patients is decreasing an excessive host inflammatory response which is responsible for serious illness and death from COVID-19.…”

Section: Introductionmentioning

confidence: 99%

“…The corticosteroids' mechanism in critically ill patients is decreasing an excessive host inflammatory response which is responsible for serious illness and death from COVID-19. Interleukin-1 and interleukin-6 are cytokines that are released into infection and stimulate acute-phase and fever responses (3,4). Anakinra is a recombinant monoclonal antibody and a slightly modified version of the human interleukin-1 receptor antagonist protein which received approval to treat rheumatoid arthritis, idiopathic pulmonary fibrosis and auto-inflammatory diseases such as the Familial Mediterranean Diseases (5,6).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Tocilizumab and Anakinra in the Treatment of COVID-19: A Single-Center Experience

Acat

ÇAVDAR

TEZCE

et al. 2022

Düzce Tıp Fakültesi Dergisi

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Aim: The aim of this study was to examine whether a difference between endotracheal intubation, non-invasive mechanical ventilation, high flow oxygen therapy requirements and 28-day mortality rate in severe and critical coronavirus disease 2019 (COVID-19) patients receiving anakinra and tocilizumab treatment. Material and Methods: A total of 70 patients infected with COVID-19, who were treated with tocilizumab and anakinra from April 2020 to March 2021 at Karabük Training and Research Hospital, were recruited in this retrospective study. Data on patient demographics, comorbidities, treatments, clinical outcomes of the patients’ and hemogram findings were retrieved from hospital records. Results: The mean age of the patients was 61.34±11.8 years. Of the 70 patients, 12 (17.1%) were female and 58 (82.9%) were male. Severe and critical COVID-19 cases were evident in 48 (68.6%), and 22 (31.4%) patients, respectively. The mortality rate in 28 days was not statistically significantly different between the tocilizumab and anakinra groups (p=0.999). Both the necessity of high flow oxygen therapy and non-invasive mechanical ventilation were lower in the tocilizumab group than in the anakinra group (p<0.001, and p=0.002, respectively), while there was no statistically significant difference in the necessity of intubation between the two groups (p=0.999). The length of stay was also significantly shorter in the tocilizumab group (p=0.027). Conclusion: High flow oxygen therapy, non-invasive mechanical ventilation requirements, and length of stay were significantly lower than anakinra in the tocilizumab group. Excessive inflammatory response with cytokine storm features causes severe disease course and worsens prognosis in COVID-19.

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Corticosteroid use in COVID-19 pneumonia

Cited by 4 publications

References 0 publications

The role of endotheliitis in COVID‐19: Real‐world experience of 11 190 patients and literature review for a pathophysiological map to clinical categorisation

The role of endotheliitis in COVID‐19: Real‐world experience of 11 190 patients and literature review for a pathophysiological map to clinical categorisation

Clinical study of invasive pulmonary aspergillosis following influenza A H1N1

Comparison of Tocilizumab and Anakinra in the Treatment of COVID-19: A Single-Center Experience

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