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Effect of methylprednisolone in reducing severe COVID-19 and mortality in high-risk patients: A retrospective study
Yan Xiao1, Jinwei Wang1, Kai Yang1
1Respiratory Infection and Critical Disease Diagnosis and Treatment, Beijing Gobroad Boren Hospital, Beijing, China.
Insights
Low-dose methylprednisolone effectively treats high-risk COVID-19 patients. Timely administration with ground-glass opacities on CT scans reduces severe disease and mortality, promoting inflammation remission.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Glucocorticoids are effective for severe COVID-19, but guidelines lack comprehensive indications for high-risk patients.
- Effective treatment strategies for high-risk COVID-19 patients remain a significant clinical challenge.
Purpose of the Study:
- To identify optimal treatments for high-risk COVID-19 patients.
- To analyze the impact of methylprednisolone on severe COVID-19 outcomes in a high-risk cohort.
Main Methods:
- Retrospective analysis of epidemiological, clinical, and laboratory data from 33 high-risk COVID-19 patients.
- Categorization into mild-to-moderate (n=26) and severe (n=7) COVID-19 groups.
- Chest CT imaging guided methylprednisolone administration, with outcomes including mechanical ventilation duration, ICU stay, and 28-day mortality.
Main Results:
- 12.1% of patients required mechanical ventilation with a mean PaO2/FiO2 ratio of 279.
- No co-infections were detected.
- Mechanical ventilation duration averaged 16 days, ICU stay was 11 days, and 28-day mortality was 3.0%.
Conclusions:
- Low-dose, timely methylprednisolone administration is linked to reduced severe COVID-19 rates and mortality in high-risk individuals.
- For patients with ground-glass opacities on CT scans, continuous low-dose methylprednisolone aids inflammation remission and prevents severe disease progression or death.
Introduction:
The treatment of COVID-19 patients, especially high-risk patients, remains a large challenge. Glucocorticoids have been accepted as effective medicines for severe COVID-19. However, the glucocorticoid usage guidelines do not cover all the indications for high-risk patients.
Objective:
To identify more effective treatments for high-risk patients with COVID-19, this retrospective study analyzed routine epidemiological, clinical, and laboratory data from 33 high-risk patients with COVID-19 in Beijing Gobroad Boren Hospital, Beijing, China, most of whom responded well to treatment.
Methods:
Severe acute respiratory syndrome coronavirus-2 infection was confirmed via real-time reverse transcriptase polymerase chain reaction assays. Outcome measures such as duration of mechanical ventilation, intensive care unit length of stay, and 28-day mortality were analyzed. Patients were divided into two groups: mild to moderate COVID-19 (n = 26) and severe COVID-19 (n = 7). Chest computed tomography images were used to guide methylprednisolone administration or withdrawal.
Results:
Upon intensive care unit admission, 12.1% of patients were mechanically ventilated with an average partial pressure of oxygen/fraction of inspired oxygen(PaO2/FiO2) ratio of 279 ± 146. No coinfections with other endemic viruses were observed. The duration of mechanical ventilation was 16 days (interquartile range: 8-28); the intensive care unit length of stay was 11 (interquartile range: 2-33) days; and the 28-day total mortality was 3.0%.
Conclusion:
Multivariate regression analysis revealed that low-dose, timely methylprednisolone administration was associated with a lower severe COVID-19 rate and mortality in high-risk patients. For high-risk patients, once there are ground-glass opacities (GGO) in the computed tomography image, continuous and low-dose methylprednisolone administration promotes inflammation remission and protects them from severe COVID-19 or mortality.
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