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
Abstract
BACKGROUND

The coronavirus disease 2019 (COVID-19) outbreak has brought great challenges to public health. Aggravation of COVID-19 is closely related to the secondary systemic inflammatory response. Glucocorticoids are used to control severe diseases caused by the cytokine storm, owing to their anti-inflammatory effects. However, glucocorticoids are a double-edged sword, as the use of large doses has the potential risk of secondary infection and long-term serious complications, and may prolong virus clearance time. Nonetheless, the risks and benefits of glucocorticoid adjuvant therapy for COVID-19 are inconclusive.

AIM

To determine the effect of methylprednisolone in severe and critically ill patients with COVID-19.

METHODS

This single-center retrospective study included 102 adult COVID-19 patients admitted to a ward of a designated hospital in Wuhan, Hubei Province from January to March 2020. All patients received general symptomatic treatment and organ function support, and were given different respiratory support measures according to their conditions. In case of deterioration, considering the hyperinflammatory state of the patients, methylprednisolone was intravenously administered at 0.75-1.5 mg/kg/d, usually for less than 14 d. Patient vital signs and oxygenation were closely monitored, in combination with imaging and routine blood tests such as C-reactive protein, biochemical indicators (liver and kidney function, myocardial enzymes, electrolytes, etc.), and coagulation function. Patient clinical outcomes were discharge or death.

RESULTS

A total of 102 severe and critically ill COVID-19 patients were included in this study. They were divided into treatment (69, 67.6%) and control groups (33, 32.4%) according to methylprednisolone use. Comparison of baseline data between the two groups showed that the treatment group patients had higher aspartic acid aminotransferase, globulin, hydroxybutyrate dehydrogenase, and lactate dehydrogenase. There was no significant difference in other baseline data between the two groups. With regard to prognosis, 29 (78.4%) patients in the treatment group died as opposed to 40 (61.5%) in the control group. The mortality was higher in the treatment group than in the control group; however, according to the log-rank test and the Kaplan–Meier survival curve, the difference in mortality between both groups was insignificant (P = 0.655). The COX regression equation was used to correct the variables with differences, and the results showed that methylprednisolone treatment did not improve prognosis.

CONCLUSION

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

Keywords: COVID-19; Glucocorticoids; Methylprednisolone; Cytokine storm; Coronavirus infections; Cytokines

Core Tip: Glucocorticoids were used in the treatment of severe acute respiratory syndrome, influenza A, and coronavirus disease 2019 (COVID-19) in the past. Many studies believe that glucocorticoids can effectively reduce inflammation caused by viruses. In this study, 102 patients with severe and critical COVID-19 were studied and divided into either a treatment group or a control group according to methylprednisolone use. We found that the difference in mortality between both groups was insignificant (P = 0.655), and the results showed that methylprednisolone treatment did not improve prognosis.