Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3546
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
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.
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.
The aim of the present study was to investigate the effectiveness of adjunctive corticosteroid administration in patients with severe COVID-19.
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.
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.
Adjunctive corticosteroid use did not significantly improve clinical outcomes in severe COVID-19 patients, but might promote the absorption of pulmonary lesions.
Adjunctive corticosteroid treatment in severe COVID-19 patients should be comprehensively evaluated and used with caution.