Adv Med Sci. 2021 Apr 24;66(2):262-268. doi: 10.1016/j.advms.2021.04.002. Online ahead of print.
PURPOSE: Severe coronavirus disease 2019 (COVID-19) is strongly related to interstitial pneumonia with frequent development of acute respiratory distress syndrome (ARDS). The role of corticosteroids (CS) treatment in these patients is still controversial. Some studies evidenced a possible role of an early short-term course of CS treatment in the treatment of severe pneumonia.
PATIENTS AND METHODS: This is a single-center, retrospective study considering the patients with confirmed COVID-19 pneumonia admitted to our hospital between 9th March and 15th June 2020. Two groups were considered: early high-dose of methyl-prednisolone (eHDM; n = 31) and the control group (n = 52). Patients in the eHDM group received the dose of 5-8 mg/kg/day of methyl-prednisolone for 2 consecutive days. Primary outcome was the mortality evaluation; secondary outcomes were clinical improvement, side-effects and laboratory/radiographic changes.
RESULTS: Significant differences between the two groups were: length of hospitalization (21.5 vs 28.4 days, p = 0.026), length of non-invasive ventilation (NIV) or mechanical ventilation (11.5 vs 14.5 days, p = 0.031), death (5 vs 12, p = 0.006) and clinical improvement (16 vs 11, p=0.018). The following factors were related to in-hospital mortality in the multivariate analysis: comorbidities (OR = 2.919; 95%CI = 1.515-16.705; p<0.001), days from the onset of symptoms and the hospital admission (OR = 1.404; 95%CI = 1.069-12.492; p = 0.011), PaO2/FiO2 (P/F) ratio (OR = 3.111; 95%CI = 2.334-16.991; p = 0.009) and eHDM treatment (OR = 0.741; 95%CI = 0.129-0.917; p = 0.007).
CONCLUSION: The eHDM is an interesting and promising approach in the ARDS related to COVID-19 pneumonia, which reduces mortality, length of hospitalization and the need for mechanical ventilation.