Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 14, 2022; 10(2): 426-436
Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.426
Methylprednisolone accelerate chest computed tomography absorption in COVID-19: A three-centered retrospective case control study from China
Lan Lin, Dan Xue, Jin-Hua Chen, Qiong-Ying Wei, Zheng-Hui Huang
Lan Lin, Dan Xue, Qiong-Ying Wei, Zheng-Hui Huang, Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Jin-Hua Chen, Department of Medical Administration, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Lin L and Huang ZH designed the study and drafted the manuscript; Lin L, Xue D, Wei QY and Huang ZH were responsible for the clinical treatment of patients and conducted the acquisition of clinical data; Chen JH conducted the acquisition, analysis and interpretation of data; Chen JH and Huang ZH revised the manuscript for relevant important intellectual content; all authors have read and approved the final version of the manuscript.
Supported by the Fujian Medical University COVID-19 Prevention and Treatment Research Contingency Key Project, No. 2020YJ006; the Science and Technology Program Guided Projects, Fujian Province, China, No. 2020Y0036.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Fujian Medical University Union Hospital Institutional Review Board (No. 2020KJTXGF001).
Informed consent statement: Patients signed an informed consent.
Conflict-of-interest statement: The authors have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zheng-Hui Huang, MD, Associate Chief Physician, Department of Respiratory Medicine, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou 350001, Fujian Province, China. 13665028181@163.com
Received: August 17, 2021
Peer-review started: August 17, 2021
First decision: November 3, 2021
Revised: November 12, 2021
Accepted: December 2, 2021
Article in press: December 2, 2021
Published online: January 14, 2022
Processing time: 147 Days and 15.6 Hours
Abstract
BACKGROUND

Based on the results of some large randomized controlled trials (RCTs) confirmed the efficacy of corticosteroids in coronavirus disease 2019 (COVID-19), corticosteroids have been included in World Health Organization guidelines, but remain controversial.

AIM

To investigate the efficacy and safety of low-to-moderate dose (30 to 40 mg/d) short-term methylprednisolone for COVID-19 patients.

METHODS

The clinical data of 70 patients diagnosed with COVID-19 who received antiviral therapy with Arbidol for 7-10 d before admission but had no obvious absorption on chest computed tomography (CT) imaging were retrospectively analyzed. Arbidol (as the control group) and methylprednisolone (as the corticosteroid group) were given respectively after admission. After treatment, chest CT was reexamined to evaluate the absorption of pulmonary lesions. Additionally, we evaluated and compared the lymphocyte count, erythrocyte sedimentation rate (ESR), interleukin-6(IL-6), serum ferritin, lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB), hypersensitive C-reactive protein (hs-CRP) and D-dimer levels, and also analyzed the incidence of toxic and side effects.

RESULTS

All patients in the corticosteroid group had varying degrees of CT absorption, which was significantly better than that in the control group (CT obvious absorption rate: 89.47% vs 12.5%, P < 0.05). The average daily dose and course of methylprednisolone in the patients with significant improvement on chest CT was (38.55 ± 13.17) mg and (6.44 ± 1.86) d respectively. During the treatment, the lymphocyte count, ESR, IL-6, serum ferritin, LDH, CK-MB, hs-CRP and D-dimer levels all improved gradually, indicating that both Arbidol and methylprednisolone therapy were contributed to improving the condition of COVID-19 patients. The corticosteroid regimen did not prolong the clearance time of severe acute respiratory syndrome coronavirus 2. There were no severe adverse reactions such as gastrointestinal bleeding, secondary severe infection, hypertension, diabetic ketoacidosis, mental disorders or electrolyte disorders during the whole corticosteroid treatment process.

CONCLUSION

Low-to-moderate dose short-term methylprednisolone can accelerate the chest CT imaging absorption of COVID-19 so as to improve symptoms and alleviate the condition in a short term, reduce the hospital stay, meanwhile avoid severe COVID-19 phases. The protocol has been proven to be effective and safe in clinical use.

Keywords: Coronavirus disease 2019; Corticosteroid; Methylprednisolone; Treatment

Core Tip: This study aimed to explore the efficacy and safety of methylprednisolone for treating coronavirus disease 2019 (COVID-19). Low-to-moderate dose short-term methylprednisolone could accelerate the chest computed tomography imaging absorption of COVID-19 and prevent it from deteriorating into critical type, shorten hospital stay and save medical resources.