Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2020; 8(23): 5952-5961
Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.5952
Effect of methylprednisolone in severe and critical COVID-19: Analysis of 102 cases
Hong-Ming Zhu, Yan Li, Bang-Yi Li, Shuang Yang, Ding Peng, Xiaojiao Yang, Xue-Lian Sun, Mei Zhang
Hong-Ming Zhu, Bang-Yi Li, Shuang Yang, Ding Peng, Mei Zhang, Department of Gastroenterology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
Yan Li, Department of Pulmonology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
Xiaojiao Yang, School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Montreal, QC H9X 3V9, Canada
Xue-Lian Sun, Department of Emergency Medicine, Xuanwu Hospital of Capital Medical University, Beijng 100053, China
Author contributions: Zhu HM wrote the paper; Zhang M designed the research; Li Y and Yang S performed the research; Peng D and Yang X performed data and statistical analyses; Peng D and Li BY analyzed the data; Sun XL collected the data.
Institutional review board statement: This survey was a retrospective study collecting only the clinical data of patients. Since it did not bring risks to patients’ physiology and did not interfere with patients’ treatment plan, and researchers protected patients’ information from disclosure, Xuanwu Hospital of Capital Medical University agreed to exempt this study from ethical review.
Informed consent statement: The need for individual consent was waived by the committee.
Conflict-of-interest statement: The authors declare no conflict of interest regarding the manuscript.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mei Zhang, MD, Chief Physician, Occupational Physician, Professor, Department of Gastroenterology, Xuanwu Hospital of Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. zhang2955@sina.com
Received: August 28, 2020
Peer-review started: August 28, 2020
First decision: September 29, 2020
Revised: October 3, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: December 6, 2020
Processing time: 97 Days and 15.4 Hours
ARTICLE HIGHLIGHTS
Research background

Coronavirus disease 2019 (COVID-19) has spread to many countries and regions all over the world and has become a worldwide public health event. COVID-19 is an acute infectious disease caused by a new coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], which is clinically categorized into mild, moderate, severe, and critical illness. Severe and critically ill patients progress rapidly with dyspnea, hypoxemia, and even life-threatening complications such as multiple organ dysfunction syndrome, sepsis, and shock. At present, there is no significant and effective drug for severe and critical patients with COVID-19. Glucocorticoids have been used in the treatment of SARS, Middle East respiratory syndrome, influenza A, and other infectious respiratory diseases worldwide, but their efficacy is still controversial.

Research motivation

In clinical practice, some severe and critical patients with COVID-19 benefit from the application of glucocorticoids, but some patients have various adverse effects. Therefore, whether glucocorticoids should be used in patients with COVID-19 and how to use them are a problem worthy of discussion.

Research objectives

The main objective of this study was to determine the effect of methylprednisolone in severe and critical patients with COVID-19.

Research methods

One hundred and two severe and critically ill patients with COVID-19 were divided into treatment (69, 67.6%) and control groups (33, 32.4%). In the treatment group, methylprednisolone was intravenously administered at 0.75-1.5 mg/kg/d, usually for less than 14 d. We compared the general information, underlying diseases, laboratory examination indexes, and mortality of the two groups. The log-rank test and the Kaplan–Meier survival curve were used to explore the difference in mortality between the two groups, and the COX regression equation was used to correct the variables with differences.

Research results

The treatment group patients had higher aspartic acid aminotransferase (P < 0.01), globulin (P < 0.01), hydroxybutyrate dehydrogenase (P < 0.01), and lactate dehydrogenase (P < 0.01). Twenty-nine (78.4%) of patients in the treatment group died as opposed to 40 (61.5%) in the control group. The mortality was higher than that of the control group. And the results showed that methylprednisolone treatment did not improve prognosis.

Research conclusions

Methylprednisolone treatment does not improve prognosis in severe and critical COVID-19 patients.

Research perspectives

Methylprednisolone treatment in severe and critically ill patients with COVID-19 should be comprehensively evaluated and used with caution.