SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’

Kory, Pierre; Kanne, Jeffrey P.

doi:10.1136/bmjresp-2020-000724

Cited by 106 publications

(109 citation statements)

References 30 publications

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“…The presence of OP likely explains both the seemingly baffling clinical presentation of early COVID-19 respiratory disease as well as the efficacy of corticosteroids as evidenced in a recent review by one of the authors (PK). 7,8…”

Section: Introductionmentioning

confidence: 99%

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RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Kory

Meduri

Iglesias

et al. 2020

J Intensive Care Med

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In December 2019, COVID-19, a severe respiratory illness caused by the new coronavirus SARS-CoV-2 (COVID-19) emerged in Wuhan, China. The greatest impact that COVID-19 had was on intensive care units (ICUs), given that approximately 20% of hospitalized cases developed acute respiratory failure (ARF) requiring ICU admission. Based on the assumption that COVID-19 represented a viral pneumonia and no anti-coronaviral therapy existed, nearly all national and international health care societies’ recommended “supportive care only” avoiding other therapies outside of randomized controlled trials, with a specific prohibition against the use of corticosteroids in treatment. However, early studies of COVID-19-associated ARF reported inexplicably high mortality rates, with frequent prolonged durations of mechanical ventilation (MV), even from centers expert in such supportive care strategies. These reports led the authors to form a clinical expert panel called the Front-Line COVID-19 Critical Care Alliance (www.flccc.net ). The panel collaboratively reviewed the emerging clinical, radiographic, and pathological reports of COVID-19 while initiating multiple discussions among a wide clinical network of front-line clinical ICU experts from initial outbreak areas in China, Italy, and New York. Based on the shared early impressions of “ what was working and what wasn’t working,” the increasing medical journal publications and the rapidly accumulating personal clinical experiences with COVID-19 patients, a treatment protocol was created for the hospitalized patients based on the core therapies of methylprednisolone, ascorbic acid, thiamine, heparin and co-interventions (MATH+). This manuscript reviews the scientific and clinical rationale behind MATH+ based on published in-vitro, pre-clinical, and clinical data in support of each medicine, with a special emphasis of studies supporting their use in the treatment of patients with viral syndromes and COVID-19 specifically. The review concludes with a comparison of published multi-national mortality data with MATH+ center outcomes.

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Section: Introductionmentioning

confidence: 99%

“…The MATH+ authors did not possess such equipoise, as we held a collective belief as to the critical importance of corticosteroid therapy in COVID-19, as evidenced above. 6,8,23…”

Section: Introductionmentioning

confidence: 99%

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Kory

Meduri

Iglesias

et al. 2020

J Intensive Care Med

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“…Pathology in patients who recovered from SARS-CoV has shown brogranulation tissue proliferation and organizing pneumonia like patterns [21] while MERS associated organizing pneumonia has also been documented [22,23]. Studies of COVID-19 CT imaging, along with postmortem lung biopsies and autopsies during the ongoing pandemic, suggest the development of a secondary OP, which at present remains an underrecognized complication [24].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Interstitial Lung Disease - An Emerging Entity

Zubairi¹,

Shaikh

Zubair

et al. 2020

Preprint

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Background: COVID-19 disease associated pulmonary sequalae has been increasingly reported after recovery from acute infection. Therefore, we aim to explore the charactersitics of interstitial lung disease in patients with COVID-19.Methods: An observational study was conducted in patients with COVID-19 associated ILD from April 2020 till September 2020. Patients ≥18 years of age with COVID-19 who were diagnosed with ILD based on respiratory symptoms and HRCT chest imaging after the recovery phase of COVID-19 infection were recruited. Data was recorded on a structured proforma, and descriptive analysis was performed using Stata version 12.1.Results: A total of 30 patients with COVID-associated ILD were identified. The mean age of patients was 59.14 (SD 12.60) and 27 (90%) were males. Four HRCT patterns of interstitial lung disease were seen; organizing pneumonia in 10 (33.33%), non-specific interstitial pneumonitis in 17 (56.67%), usual interstitial pneumonitis in 12 (40%) and probable usual interstitial pneumonitis in 14 (46.67%). Diffuse involvement was found in 15 (50%) patients, while peripheral predominance in 15 (50%) and other significant findings were seen in 8 (26.67%) patients. All patients were treated with corticosteroids. The case fatality rate was 16.67%. Amongst the survivors, 8 (32%) recovered completely, 9 (36%) improved, while 8 (32%) patients had static or progressive disease.Conclusions: This is the first study from Southeast Asia that identified COVID-associated interstitial lung disease in patients who had no pre-existing lung disease, highlighting the importance of timely recognition and treatment of an entity that might lead to fatal outcome.

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“…[27] However, a prospective study of 38,378 males followed over 10 years did not associates vitamin C status with community-acquired pneumonia. [28] Since COVID-19 pneumonia and post-mortem investigations have demonstrated a secondary organising pneumonia phenomenon [29] studies investigating vitamin C in relation to pneumonia may be relevant.…”

Section: Vitamin C Covid-19 and Pneumoniamentioning

confidence: 99%

Vitamin C—An Adjunctive Therapy for Respiratory Infection, Sepsis and COVID-19

Holford¹,

Carr²,

Jovic³

et al. 2020

Preprint

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There are limited proven therapies for the treatment of COVID-19. Vitamin C’s antioxidant, anti-inflammatory and immunomodulating effects, make it a potential therapeutic candidate, both for the prevention and amelioration of COVID-19 infection, and as an adjunctive therapy in the critical care of COVID-19, supporting anti-inflammatory treatment. This literature review focuses on vitamin C deficiency in respiratory infections including COVID-19; the mechanism of action in infectious disease and adrenal function supporting the anti-inflammatory actions of glucocorticosteroids: its role in preventing and treating colds and pneumonia and its role in treating sepsis and COVID-19. The evidence to date indicates that oral vitamin C (2-8g/d) may reduce incidence and duration of respiratory infections and intravenous vitamin C (2-24g/d) has been shown to reduce mortality, Intensive Care Unit and hospital stays, time on mechanical ventilation in severe respiratory infections. Further trials are urgently warranted. Given the favourable safety profile and low cost of vitamin C, and frequency of vitamin C deficiency in respiratory infections it may be worthwhile testing patients’ vitamin C status and treating accordingly with intravenous use within ICUs and orally with doses between 2 and 8g/day in hospitalised and infected persons.

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SARS-CoV-2 organising pneumonia: ‘Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?’

Cited by 106 publications

References 30 publications

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

COVID-19 Associated Interstitial Lung Disease - An Emerging Entity

Vitamin C—An Adjunctive Therapy for Respiratory Infection, Sepsis and COVID-19

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