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High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory
Miguel Ángel López Zúñiga1,2, Aida Moreno-Moral3, Ana Ocaña-Granados4
1Infectious Diseases Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.
Insights
High-dose corticosteroid pulse therapy (HDCPT) significantly reduced mortality in COVID-19 patients with hyper-inflammatory responses. Laboratory markers can identify patients who benefit from this intervention, improving COVID-19 survival rates.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- COVID-19 can trigger a hyper-inflammatory response, leading to increased mortality.
- Identifying patients at risk of this response is crucial for timely intervention.
- High-dose corticosteroid pulse therapy (HDCPT) is a potential treatment for severe inflammatory conditions.
Purpose of the Study:
- To evaluate the association between HDCPT (methylprednisolone or dexamethasone) and survival in COVID-19 patients at risk of hyper-inflammation.
- To establish initial diagnostic criteria using laboratory markers for stratifying patients who may benefit from HDCPT.
Main Methods:
- Prospective observational study of 318 COVID-19 patients.
- Multivariate Cox regression analysis to assess HDCPT's impact on mortality, controlling for covariates.
- 30-day analysis of laboratory markers in survivors versus non-survivors to identify stratification markers.
Main Results:
- HDCPT was associated with a statistically significant decrease in mortality (HR = 0.087, P < 0.001).
- Significant differences in pro-inflammatory markers were observed between survivors and non-survivors.
- Proposed diagnostic criteria for hyper-inflammation risk: IL-6 ≥ 40 pg/ml, and/or two of CRP ≥ 100 mg/L, D-dimer ≥ 1000 ng/ml, ferritin ≥ 500 ng/ml, LDH ≥ 300 U/L.
Conclusions:
- HDCPT is an effective intervention for increasing survival in COVID-19 patients with hyper-inflammatory responses.
- Laboratory marker tests can effectively stratify patients who require HDCPT.
- Further randomized clinical trials are recommended to confirm HDCPT's efficacy in improving COVID-19 survival rates.
Objective:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
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