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).