Efficacy of pulse steroid therapy in patients critically ill with COVID-19

Abstract

OBJECTIVES: The aim of this study was to determine the effi cacy of pulse steroid therapy administered to patients critically ill with COVID-19 progressing into severe pneumonia. METHODS: A total of 600 patients included in this retrospective study were divided into three groups. Group 1 (control group): 200 patients who did not receive steroid treatment, Group 2: 200 patients who received dexamethasone 1x8 milligram (mg) or methylprednisolone 1x80 mg, Group 3: (pulse steroid therapy group): 200 patients who received 1 g methylprednisolone followed by 1x80 mg methylprednisolone. Demographic and laboratory data were recorded. RESULTS: Mortality rates in groups 1, 2 and 3 were 77 %, 53.55 %, and 58.5 %, respectively. The ratios of intubated patients in groups 1, 2 and 3 were 70 %, 45.5 % and 56 %, respectively. The numbers of patients whose D-dimer values were above 2,250 ng/mL (cut-off value for D-dimer in this study) in groups 2, 1 and 3 were 65, 107, and 105, respectively. CONCLUSION: Pulse steroid therapy does not shorten the duration of hospital stay, does not reduce the need for intubation and increases the risk of thrombosis by signifi cantly increasing the level of D-dimer among patients critically and severely ill with Fig. 3, Ref. 20).

Pulse versus nonpulse steroid regimens in patients with coronavirus disease 2019: A systematic review and meta‐analysis

“…9 Our study results were consistent with a cohort study conducted by Ho et al in 2003, 10 which showed no differences in mortality or need for endotracheal intubation between PDS and NPDS in the management of patients with SARS. In this meta-analysis, we found similar results to those from a study by Gundogdu et al, 19 which showed that PDS and NPDS were associated with similar mortality (58.5% and 53.5%, respectively). Furthermore, our meta-analysis results remained consistent on subgroup analysis based on the strategy of PDS therapy (initial vs. rescue therapy).…”

“…Subsequently, we excluded 1558 studies because of the following: 1391 studies used inappropriate doses of steroids or lacked the appropriate comparison, 128 studies did not report data regarding the interventions of interest, and 39 studies were excluded due to lack of the appropriate outcomes of interest. Eventually, 10 studies met our inclusion criteria and were included in the meta‐analysis 14–19,22–25 . Figure 1 shows the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flow chart that illustrates how the final studies were selected.…”

“…Four studies 14,19,23,24 reported the adverse events in the form of superimposed infection or bacterial growth in bodily fluid cultures.…”

“…[14][15][16] Several studies have compared PDS versus nonpulse dose steroids (NPDS) with conflicting results. 14,[17][18][19] Data regarding the role of PDS in COVID-19 are still unclear.…”

“…Coronavirus disease 2019 (COVID- 19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, first discovered in China in December 2019, and has become a worldwide pandemic leading to significant morbidity and mortality. 1,2 The acute respiratory distress syndrome (ARDS) due to viral pneumonitis is one of the leading causes of mortality among patients with COVID-19.…”