Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2021; 9(15): 3546-3558
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3546
Effectiveness of adjunctive corticosteroid therapy in patients with severe COVID-19: A retrospective cohort study
Bin Xiong, Li-Min He, Yuan-Yuan Qin, Hu Du, Zhu Zhan, Yi-Hong Zhou, Yao-Kai Chen, An Zhang
Bin Xiong, Hu Du, Zhu Zhan, An Zhang, Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Li-Min He, Department of Cardiology, The First Branch of The First Affiliated Hospital, Chongqing Medical University, Chongqing 400015, China
Yuan-Yuan Qin, Yi-Hong Zhou, Yao-Kai Chen, Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
Author contributions: Xiong B and He LM contributed to the writing of the manuscript; Zhang A and Chen YK conceived and designed the experiments; Du H, Zhan Z and Xiong B collected the epidemiological and clinical data; Xiong B and He LM analyzed the data; Qin YY, Zhou YH, Chen YK and Zhang A revised the final manuscript; all authors read and approved the final manuscript.
Supported by the Chongqing Special Research Project for Novel Coronavirus Pneumonia Prevention and Control, No. csct2020jscx-fyzxX0012 and No. csct2020jscx-fyzxX0005; and Emergency Research Project of COVID-19 of Chongqing Health Commission, No. 2020NCPZX04.
Institutional review board statement: This study was approved by the Ethics Commission of the Chongqing Public Health Medical Center, No.2020-025-KY.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. Written informed consent was waived by the Ethics Committee of the designated hospital.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
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: An Zhang, MD, PhD, Chief Doctor, Professor, Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing 400010, China. 300704@hospital.cqmu.edu.cn
Received: January 5, 2021
Peer-review started: January 5, 2021
First decision: January 17, 2021
Revised: January 21, 2021
Accepted: March 6, 2021
Article in press: March 6, 2021
Published online: May 26, 2021
ARTICLE HIGHLIGHTS
Research background

The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently a serious global public health challenge. Severe cases involve acute respiratory distress syndrome, sepsis, and septic shock. At present, there is no significant and effective drug for severe COVID-19 patients. Corticosteroids have been used in the treatment of virus pneumonia, such as SARS, Middle East respiratory syndrome, and influenza A, but their efficacy is still inconclusive.

Research motivation

In clinical practice, some severe COVID-19 patients will benefit from the application of corticosteroids, but there are also adverse reactions. Therefore, whether corticosteroids should be used in COVID-19 patients and how to use them are issues worthy of discussion.

Research objectives

The aim of the present study was to investigate the effectiveness of adjunctive corticosteroid administration in patients with severe COVID-19.

Research methods

Seventy-five patients with severe COVID-19 were divided into the corticosteroid group (47, 62.7%) and the non-corticosteroid group (28, 37.3%). In the corticosteroid group, methylprednisolone was administered via intravenous injection at a dose of 1-2 mg/kg/day for 3-5 d. We assessed the changes in APACHE II score and oxygenation index (PaO2/FiO2), the changes in lymphocyte count, CD4+ T-cell count, CD8+ T-cell count, pulmonary lesion volume, LOS, and length of ICU stay, proportions of patients using mechanical ventilation, and mortality rate. We measured the extent of pneumonia with the FACT Medical Imaging System, and calculated the volumes of the lesions, ground-glass opacity (GGO), consolidation, and that of the whole lung. Finally, the volume ratio was calculated by formulas.

Research results

Seventy-five patients were included in this study. Of these, 47 patients were in the corticosteroid group and 28 patients were in the non-corticosteroid group. There were no differences between the two groups in the total length of hospital stay, the length of ICU stay, high-flow oxygen days, non-invasive ventilator days, invasive ventilation days, and mortality rate. Total lesion volume ratio, consolidation volume ratio and GGO volume ratio in the corticosteroid group decreased significantly on day 14, while those in the non-corticosteroid group did not show a significant decrease.

Research conclusions

Adjunctive corticosteroid use did not significantly improve clinical outcomes in severe COVID-19 patients, but might promote the absorption of pulmonary lesions.

Research perspectives

Adjunctive corticosteroid treatment in severe COVID-19 patients should be comprehensively evaluated and used with caution.