A review on function and side effects of systemic corticosteroids used in high-grade COVID-19 to prevent cytokine storms

Langarizadeh, Mohammad Amin; Tavakoli, Marziye Ranjbar; Abiri, Ardavan; Ghasempour, Ali; Rezaei, Masoud; Ameri, Alieh

doi:10.17179/excli2020-3196

Cited by 17 publications

(11 citation statements)

References 139 publications

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“…Concerns over the side effects of systemic corticosteroids still remain [ 48 ]. Unlike systemic corticosteroids, ICS treatment has minimal systemic effects, and the impact on COVID-19 infection in patients with asthma is still under debate [ 9 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical benefits of inhaled ciclesonide for hospitalized patients with COVID-19 infection: a retrospective study

et al. 2022

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Background The successful management of patients infected with coronavirus disease 2019 (COVID-19) with inhaled ciclesonide has been reported, however few studies have investigated its application among hospitalized patients. Methods This retrospective cohort study enrolled all adult patients admitted to our hospital with confirmed COVID-19 infection from May to June 2021. Critical patients who received mechanical ventilation within 24 h after admission and those who started ciclesonide more than 14 days after symptom onset were excluded. The in-hospital mortality rate was compared between those who did and did not receive inhaled ciclesonide. Results A total of 269 patients were enrolled, of whom 184 received inhaled ciclesonide and 85 did not. The use of ciclesonide was associated with lower in-hospital mortality (7.6% vs. 23.5%, p = 0.0003) and a trend of shorter hospital stay (12.0 (10.0–18.0) days vs. 13.0 (10.0–25.3) days, p = 0.0577). In subgroup analysis, the use of inhaled ciclesonide significantly reduced mortality in the patients with severe COVID-19 infection (6.8% vs. 50.0%, p < 0.0001) and in those with a high risk of mortality (16.4% vs. 43.2%, p = 0.0037). The use of inhaled ciclesonide also reduced the likelihood of receiving mechanical ventilation in the patients with severe COVID-19 infection. After multivariate analysis, inhaled ciclesonide remained positively correlated with a lower risk of in-hospital mortality (odds ratio: 0.2724, 95% confidence interval: 0.087–0.8763, p = 0.0291). Conclusions The use of inhaled ciclesonide in hospitalized patients with COVID-19 infection can reduce in-hospital mortality. Further randomized studies in patients with moderate to severe COVID-19 infection are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Clinical benefits of inhaled ciclesonide for hospitalized patients with COVID-19 infection: a retrospective study

et al. 2022

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“…In our study, the duration of antibiotic treatment was found to be statistically significantly higher in the steroid group. The Langarizadeh et al [ 21 ] study reports that a number of corticosteroids, including methylprednisolone and dexamethasone, demonstrated remarkable efficacy, especially for COVID-19 patients who were mechanically ventilated.…”

Section: Discussionmentioning

confidence: 99%

The effect of steroids used in the treatment of COVID-19 on infections in intensive care

Sarı¹

2022

North Clin Istanbul

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Objective: Cytokine storm in coronavirus disease 2019 (COVID-19) patients causes lung damage and acute respiratory distress syndrome (ARDS). Immunomodulators such as steroids are widely used to control this situation. This study investigates the effectiveness of steroids used in COVID-19 patients, and their effects on secondary infections, morbidity, and mortality. Methods: Data were obtained by retrospectively scanning the files of patients in our hospital’s intensive care unit clinic during the three peak periods. Results: Between the steroid and non-steroid groups, there was no statistically significant difference in reproductive rates. These rates were 49.7% and 43.2%, respectively. Reproductive rates among steroid types were determined as 25 (56.8%) in the Methylprednisolone group, 18 (69.2%) (Highest) in the Dexamethasone + Methylprednisolone group, and 54 (43.2%) (Lowest) in the Dexamethasone group. Steroid treatment duration was effective on reproduction. Steroids cause more infections, especially after invasive procedures (Tracheal intubation, central venous catheter, etc.). In the groups with and without tracheal aspirate steroids, the growth rates were 71 (76.3%) and 32 (54.2%) respectively. There was no difference in mortality between the groups. Conclusion: Cytokine storm causes lung damage and ARDS. Steroids can be useful in controlling this hyper-inflammatory situation. However, increased secondary infections, an important side effect of steroids, increase mortality. Steroids more often cause these infections, especially in patients undergoing invasive Strict adherence to infection control measures during steroid treatment will reduce this risk. In conclusion, while steroids reduce mortality by controlling the hyper-inflammatory picture, they also increase mortality with increased secondary infections. Preventing infections enables success with steroids.

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“…The headache in the later phase of the disease may fulfill the criteria for intracranial hypertension and corticosteroids might be helpful for a short period if there is no contraindication. Headache may also be due to the side effects of drugs used to treat COVID-19 patients such as hydroxychloroquine ( 92 , 93 ), baricitinib ( 94 , 95 ), and corticosteroids ( 96 ).…”

Section: Expert Opinion On the Treatment Of Headache In Covid-19mentioning

confidence: 99%

A Review on Headaches Due to COVID-19 Infection

et al. 2022

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Since December 2019, the time when the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was spotted, numerous review studies have been published on COVID-19 and its neuro invasion. A growing number of studies have reported headaches as a common neurological manifestation of COVID-19. Although several hypotheses have been proposed regarding the association between headache and the coronavirus, no solid evidence has been presented for the mechanism and features of headache in COVID-19. Headache also is a common complaint with the omicron variant of the virus. COVID-19 vaccination also is a cause of new-onset headaches or aggravation of the previous headache in migraine or tension headache sufferers. In this review study, the types of headaches reported in previous studies and their possible pathogenic mechanisms are outlined. To accomplish this objective, various types of headaches are classified and their patterns are discussed according to ICHD-3 diagnostic criteria, including, headaches attributed to systemic viral infection, viral meningitis or encephalitis, non-infectious inflammatory intracranial disease, hypoxia and/or hypercapnia, cranial or cervical vascular disorder, increased cerebrospinal fluid (CSF) pressure, refractive error, external-compression headache, and cough headache. Then, their pathogeneses are categorized into three main categories, direct trigeminal involvement, vascular invasion, and inflammatory mediators. Furthermore, persistent headache after recovery and the predictors of intensity is further investigated. Post-vaccination headache is also discussed in this review.

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A review on function and side effects of systemic corticosteroids used in high-grade COVID-19 to prevent cytokine storms

Cited by 17 publications

References 139 publications

Clinical benefits of inhaled ciclesonide for hospitalized patients with COVID-19 infection: a retrospective study

Clinical benefits of inhaled ciclesonide for hospitalized patients with COVID-19 infection: a retrospective study

The effect of steroids used in the treatment of COVID-19 on infections in intensive care

A Review on Headaches Due to COVID-19 Infection

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