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High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response
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High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response
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Journal Article
High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response
2021
Overview
Test whether high dose corticosteroid pulse therapy (HDCPT) with either methylprednisolone or dexamethasone is associated with increased survival in COVID-19 patients at risk of hyper-inflammatory response. Provide some initial diagnostic criteria using laboratory markers to stratify these patients.
This is a prospective observational study, 318 met the inclusion criteria. 64 patients (20.1%) were treated with HDCPT by using at least 1.5mg/kg/24h of methylprednisolone or dexamethasone equivalent. A multivariate Cox regression (controlling for co-morbidities and other therapies) was carried out to determine whether HDCPT (among other interventions) was associated with decreased mortality. We also carried out a 30-day time course analysis of laboratory markers between survivors and non-survivors, to identify potential markers for patient stratification.
HDCPT showed a statistically significant decrease in mortality (HR = 0.087 [95% CI 0.021-0.36]; P < 0.001). 30-day time course analysis of laboratory marker tests showed marked differences in pro-inflammatory markers between survivors and non-survivors. As diagnostic criteria to define the patients at risk of developing a COVID-19 hyper-inflammatory response, we propose the following parameters (IL-6 > = 40 pg/ml, and/or two of the following: C-reactive protein > = 100 mg/L, D-dimer > = 1000 ng/ml, ferritin > = 500 ng/ml and lactate dehydrogenase > = 300 U/L).
HDCPT can be an effective intervention to increase COVID-19 survival rates in patients at risk of developing a COVID-19 hyper-inflammatory response, laboratory marker tests can be used to stratify these patients who should be given HDCPT. This study is not a randomized clinical trial (RCT). Future RCTs should be carried out to confirm the efficacy of HDCPT to increase the survival rates of COVID-19.
Publisher
Public Library of Science,Public Library of Science (PLoS)
Subject
Adrenal Cortex Hormones - administration & dosage
/ Adult
/ Aged
/ Asthma
/ Chronic obstructive pulmonary disease
/ Complications and side effects
/ COVID-19
/ Cytokine Release Syndrome - drug therapy
/ Cytokine Release Syndrome - immunology
/ Dexamethasone - pharmacology
/ Dimers
/ Dosage
/ Editing
/ Female
/ Ferritin
/ HIV
/ Human immunodeficiency virus
/ Humans
/ Hypoxia
/ Inflammation - prevention & control
/ Kinases
/ Male
/ Medicine
/ Medicine and Health Sciences
/ Methylprednisolone - pharmacology
/ Patients
/ SARS-CoV-2 - isolation & purification
/ Serology
/ Severe acute respiratory syndrome coronavirus 2
/ Survival
/ Therapy
/ Tumors
/ Viruses
