Effectiveness of adjunctive corticosteroid therapy in patients with severe COVID-19: A retrospective cohort study

doi:10.12998/wjcc.v9.i15.3546

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May 26, 2021 (publication date) through Nov 20, 2024

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World Journal of Clinical Cases

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2307-8960

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Clin Cases. May 26, 2021; 9(15): 3546-3558
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3546

Table 1 Demographics and baseline characteristics of patients with severe coronavirus disease-19

Variables	Total (n = 75)	Corticosteroid group (n = 47)	Non-corticosteroid group (n = 28)	P value
Demographic factors
Male (%)	39 (52.00)	25 (53.19)	14 (50.00)	0.789
Age (%)	58.92 ± 14.29	57.09 ± 13.74	62.00 ± 14.90	0.151
Smoking (%)	9 (12.00)	8 (17.02)	1 (3.57)	0.083
APACHE II	7.97 ± 3.37	8.24 ± 3.57	7.52 ± 3.02	0.382
Comorbidity
Hypertension (%)	13 (17.33)	7 (14.89)	6 (21.43)	0.470
Diabetes (%)	19 (25.33)	13 (27.66)	6 (21.43)	0.548
CHD (%)	4 (5.33)	2 (4.26)	2 (7.14)	0.590
COPD (%)	7 (9.33)	3 (6.38)	4 (14.28)	0.437
Cerebrovascular disease (%)	1 (1.33)	1 (2.13)	0	1.000
Viral hepatitis (%)	1 (1.33)	1 (2.13)	0	1.000
Tumor (%)	2 (2.67)	1 (2.13)	1 (3.57)	0.707
CKD (%)	1 (1.33)	1 (2.13)	0	1.000
Symptoms
Fever (%)	46 (61.33)	31 (65.96)	15 (53.57)	0.287
Cough (%)	57 (76.00)	37 (78.72)	20 (71.43)	0.474
Sputum (%)	26 (34.67)	15 (31.91)	11 (39.29)	0.516
Dyspnea (%)	40 (53.33)	30 (63.83)	10 (35.71)	0.018
Weakness (%)	22 (29.33)	12 (25.53)	10 (35.71)	0.349
Headache (%)	8 (10.67)	4 (8.51)	4 (14.28)	0.433
Diarrhea (%)	6 (8.00)	3 (6.38)	3 (10.71)	0.819
Complication
Shock (%)	3 (4.00)	3 (6.38)	0	0.450
Leukopenia (%)	4 (5.33)	3 (6.38)	1 (3.57)	0.600
Thrombocytopenia (%)	2 (2.67)	2 (4.26)	0	0.715
Liver dysfunction (%)	3 (4.00)	2 (4.26)	1 (3.57)	0.884
AKI (%)	2 (2.67)	1 (2.13)	1 (3.57)	0.707
Cardiac injury (%)	2 (2.67)	2 (4.26)	0	0.715

AKI: Acute kidney injury; APACHE: Acute physiology and chronic health assessment; CHD: Coronary heart disease; COPD: Chronic obstructive pulmonary disease; CKD: Chronic kidney disease; SOFA: Sequential organ failure assessment.

Table 2 Treatments and outcomes in patients with severe coronavirus disease-19

Variables	Total (n = 75)	Corticosteroid group (n = 47)	Non-corticosteroid group (n = 28)	P value
Treatments
Antibiotics (%)	62 (82.67)	45 (95.74)	17 (60.71)	< 0.001
Antifungal (%)	12 (16.00)	12 (25.53)	0	0.004
IV immunoglobulin (%)	30 (42.76)	27 (57.45)	3 (10.71)	< 0.001
Thymopentin or thymalfasin (%)	63 (84.00)	43 (91.49)	20 (71.43)	0.022
High-flow oxygen (%)	40 (53.33)	28 (59.57)	12 (42.86)	0.160
Noninvasive ventilator (%)	28 (37.33)	24 (51.06)	4 (14.28)	0.001
Invasive ventilator (%)	7 (9.33)	7 (14.89)	0	0.032
ECMO (%)	3 (4.00)	3 (6.38)	0	0.450
Outcomes
Total length of hospital stay	21.05 ± 8.96	21.21 ± 9.57	20.79 ± 7.98	0.843
Length of ICU stay	14.64 ± 6.67	15.23 ± 6.72	13.64 ± 6.58	0.321
High-flow oxygen days	5.58 ± 4.19	5.32 ± 3.58	6.17 ± 5.49	0.565
Noninvasive ventilator days	6.69 ± 5.37	7.54 ± 5.46	2.60 ± 2.30	0.060
Invasive ventilator days	9.00 ± 6.14	9.00 ± 6.14	-	-
Mortality rate (%)	4 (5.33)	4 (8.51)	0	0.291

IV: Intravenous injection; ECMO: Extracorporeal membrane oxygenation; ICU: Intensive care unit.

Table 3 Comparison of laboratory variables at different follow-up points in patients with severe coronavirus disease-19

Variables	Corticosteroid group		Non-corticosteroid group
Variables	D 0	D 14	D 0	D 14
Heart rate (bpm)	84 ± 16	80 ± 16	88 ± 15	74 ± 6^b
Respiratory rate	24 ± 12	20 ± 2	20 ± 2	20 ± 2
MAP (mmHg)	90 ± 10	87 ± 11	91 ± 12	82 ± 21^b
Body temperature (℃)	37.4 ± 1.0	36.8 ± 0.5^b	37.3 ± 0.8	36.5 ± 0.3^b
APACHE II	8.24 ± 3.57	6.72 ± 4.87^b	7.52 ± 3.02	6.08 ± 3.39^b
P/F ratio (mmHg)	196.68 ± 105.70	297.47 ± 135.68^b	239.00 ± 107.76	308.20 ± 102.54^b
WBC (× 10⁹/L)	6.06 ± 3.17	6.87 ± 2.70	6.24 ± 2.72	6.36 ± 1.68
N (× 10⁹/L)	4.91 ± 3.11	5.46 ± 2.67	4.75 ± 2.57	4.11 ± 1.11
L (× 10⁹/L)	0.79 ± 0.34^a	0.84 ± 0.54^a	1.02 ± 0.39	1.13 ± 0.31
PCT (ng/mL)	0.14 ± 0.13	0.12 ± 0.11	0.07 ± 0.05	0.05 ± 0.04^b
ALT (U/L)	53.86 ± 45.69	56.18 ± 52.36	27.06 ± 14.50	38.42 ± 26.58^b
AST (U/L)	52.39 ± 44.33	60.15 ± 49.77	31.78 ± 10.39	29.49 ± 17.07
LDH (U/L)	365.63 ± 169.73	-	321.50 ± 85.82	-
Albumin (g/L)	36.27 ± 4.25	34.12 ± 3.28	37.49 ± 3.93	33.21 ± 3.64^b
TB (μmol/L)	18.22 ± 6.59	-	14.43 ± 6.96	-
CRP (mg/L)	83.19 ± 63.09	27.15 ± 20.05^b	70.92 ± 61.73	18.64 ± 11.09^b
D-dimer (mg/L)	1.86 ± 1.42	4.03 ± 5.64^b	0.58 ± 0.47	1.01 ± 0.89
IL 10 (pg/mL)	4.51 ± 2.37	6.99 ± 6.35^b	4.68 ± 1.37	3.47 ± 0.78^b
IL 6 (pg/mL)	43.35 ± 34.19	40.16 ± 28.61	33.03 ± 23.69	31.86 ± 27.13
CD 4+ T (cells/μL)	253.20 ± 144.84	374.76 ± 195.80^b	298.31 ± 164.52	430.20 ± 161.40^b
CD 8+ T (cells/μL)	157.55 ± 103.76^a	285.95 ± 248.60^b	220.55 ± 110.87	275.29 ± 108.06^b
CD 4/CD 8 Ratio	1.70 ± 0.84	1.91 ± 1.39^b	1.51 ± 0.63	1.68 ± 0.61
PT (s)	11.70 ± 1.30	11.41 ± 1.76	12.03 ± 2.16	11.42 ± 0.74
Cr (μmol/L)	64.51 ± 17.13	66.99 ± 24.80	68.94 ± 30.99	73.91 ± 50.68

ALT: Alanine aminotransferase; APACHE: Acute physiology and chronic health assessment; AST: Aspartate aminotransferase; CD: Clusters of differentiation; Cr: Creatinine; CRP: C-reactive protein; IL: Interleukin; L: Lymphocyte count; LDH: Lactic dehydrogenase; MAP: Mean arterial pressure; N: Neutrophil count; P/F ratio: PaO₂/FiO₂ or oxygenation index; PCT: Procalcitonin; PT: Prothrombin time; SOFA: Sequential organ failure assessment; T = T cell; TB = total bilirubin; WBC = white blood cell.

^aP < 0.05 vs non-corticosteroid group.

^bP < 0.05 vs baseline (D 0) in each group.

Table 4 Results of imaging evaluation in patients with coronavirus disease-19

Variables	Corticosteroid group		Non-corticosteroid group
Variables	D 0	D 14	D 0	D 14
Total lesion volume ratio (%)	22.14 ± 12.62^a	11.21 ± 8.17^b	12.80 ± 8.32	12.05 ± 9.44
Consolidation volume ratio (%)	4.59 ± 4.46^a	2.77 ± 3.99^b	1.68 ± 1.47	2.81 ± 2.87^b
GGO volume ratio (%)	17.26 ± 12.35^a	8.31 ± 5.73^b	11.30 ± 7.85	9.15 ± 7.63

^aP < 0.05 vs non-corticosteroid group.

^bP < 0.05 vs baseline (D 0) in each group. GGO: Ground-glass opacity.

Citation: Xiong B, He LM, Qin YY, Du H, Zhan Z, Zhou YH, Chen YK, Zhang A. Effectiveness of adjunctive corticosteroid therapy in patients with severe COVID-19: A retrospective cohort study. World J Clin Cases 2021; 9(15): 3546-3558
URL: https://www.wjgnet.com/2307-8960/full/v9/i15/3546.htm
DOI: https://dx.doi.org/10.12998/wjcc.v9.i15.3546