Abstract:
Introduction: Today, whereas hypoxemia and respiratory failure
is the major challenging problem in the course of severe COVID-19
pneumonia, to control the disease at a mild-moderate stage or to stop
the inflammation by recognizing the cytokine storm early should be the
most prominent goal. We aimed to reveal the clinical efficacy and safety
of short-term high-dose corticosteroids in severe COVID-19.
Material and Methods: This retrospective observational study
consisted of 54 patients who were given high-dose steroid (HDS
(>250 mg/day methylprednisolone, 3 days.). Low-dose steroid
(LDS) therapy (dexamethasone 8 mg ) was applied to all patients. HDS
group was reviewed in terms of decreasing hospital mortality and
preventing fibrosis development in follow-up.
Results: During the observation period, out of 317 severe
COVID-19 pneumonia hospitalized, HDS and LDS were administered to 54 and
216 patients, respectively. Higher body mass index, younger age, more
oxygen need of patients at admission, and more need for advanced oxygen
therapy during hospitalization were found in the HDS group
(p<0.001). Furthermore, 18.5% of patients in the HDS group
had need transfer to the intensive care unit whereas it was 3.8% in LDS
(p<0.001). Additionally, the mortality rate was determined
higher in the HDS group (25. 9% vs 9.9%, p<0.001). The HDS
group had lower saturated O2 [IQR, 85% (76-89), p
<0.001], and higher ferritin at admission. It was found that
HDS was given simultaneously with the increased ferritin with deepening
lymphopenia on the third and fifth days. There was no difference in
fibrosis development between HDS patients receive and not (15.4% vs
26.2%, p=0.11)
Conclusion: The use of HDS in hospitalized COVID-19 patients
remains unclear. Along with this, our study demonstrated the use of
high-dose corticosteroids might not be associated with a lower mortality
rate among hospitalized severe COVID-19 patients.
Key words : COVID-19, high-dose steroid, cytokine storm,
mortality, fibrosis