The role of high-dose steroid therapy in Covid-19 pneumonia
INTRODUCTION:
The novel coronavirus disease 2019 (COVID-19) continues to spread rapidly worldwide since December 2019. Due to the easy transmission of the virus by patients with mild disease or asymptomatic carriers, the number of new and severe cases are increasing day by day. Recently, also new mutant viruses considered to be more contagious contribute to the spread of the disease. As of March 28, 2021, more than 120 million COVID-19 cases have been confirmed and more than 2.5 million death tolls have been reported in 192 countries or regions (1).
Although some factors related to the severity of the disease are determined, the clinical course may differ into three stages: asymptomatic (stage 1), nonsevere (stage 2), and severe with respiratory failure (stage 3) (2). Cytokine storms can appear in the second or third week in people with severe disease. However, a few clinical courses and predictors for the prognosis and mortality were reported, but it still remains to be fully investigated who will be recovered or not (2). Currently, while no specific antiviral or immunomodulatory treatment for COVID-19 has proven effective, therapies recommended for patients with COVID-19 mostly consisting of a set of supportive care strategies and previous antiviral therapies. In this case, to control the disease at a mild-moderate level or to stop the inflammation and prevent going to respiratory failure by recognizing the cytokine storm period early is the most prominent goal.
In the SARS-CoV pandemic that affected the world in 2003, T-helper lymphocyte type 1 (Th1) cytokine interferon (IFN)-γ, Th1 chemokine IFN-γ-inducible protein-10 (IP-10), pro-inflammatory cytokines interleukin (IL)-1β, IL-6, IL-8, IL-12, and monocyte chemoattractant protein levels were found to be increased. Glucocorticosteroids (GCs) are one of the most common anti-inflammatory agents with a long history of use. GCs are known to reduce neutrophil chemokine, IL-8 and monocyte chemoattractant protein-1(MCP-1), IP-10 with IFN-γ and also to inhibit ribonucleic acid responses, IL-6 and Th2 response, IL-4 (3). Both the Infectious Diseases Society of America (IDSA) and the World Health Organization (WHO, 2020) recommended the use of corticosteroids in only hospitalized severe COVID-19 patients based on the demonstration of a remarkable reduction in mortality and mechanical ventilation requirement in both an open-label, multicenter, randomized, controlled clinical trial of critically ill patients with COVID-19 patients and reported case reports in their current guidelines (4-8). However, although the routine use of GCs is not recommended in COVID-19, a systematic review of 41 studies of 25 protocols for treatment of COVID-19 revealed that corticosteroid therapy was commonly used in different doses and regimens (9).
In this study we aimed to reveal the clinical efficacy and safety of short-term high-dose GC therapy (a three-day course with one-week maintenance) in severe COVID-19 pneumonia followed at outside intensive care unit.
MATERIAL-METHODS:
Study participants:
This retrospective observational study consisted of 54 patients with severe COVID-19 pneumonia who required further treatment in a tertiary chest disease and thoracic surgery training hospital between 01 Sep 2020 and 01 Oct 2020. All participants were followed by five chest physicians in the four thoracic clinics-outside of the intensive care unit (ICU). All tests, procedures, therapies were ordered by the attending physicians.
The study was approved by the Ethics Committee of Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital (697/ Oct 15, 2020).