High Dose Steroid Therapy to Prevent Severe Hypoxia in COVID-19 Patients: A Potential Solution for Low Resource Clinical Setting

Edara, Lokesh; Suvvari, Tarun Kumar; Kutikuppala, LV Simhachalam

doi:10.7759/cureus.12330

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…In a study from Tokyo, Japan, 16 (66.7%) of 24 patients received high-dose methylprednisolone (500–1000 mg) [ 21 ]. In a report of two cases, there was a suggestion that high-dose steroid might be of benefit in low resource countries [ 23 ]. In a retrospective study comparing high-dose versus conventional doses of corticosteroid, it was noted that high-dose group were more likely to have comorbid conditions [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcome of Low and High Corticosteroids in Admitted COVID-19 Patients

AlBahrani¹,

Al‐Tawfiq²,

Jebakumar³

et al. 2021

JEGH

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Introduction:There is no specific anti-viral therapies for 2019 Coronavirus Diseases (COVID-19) infection. Here, we compared patients receiving steroids at different dosages versus no steroids in severe and critical COVID-19 patients. Methods:We retrospectively studied COVID-19 patients who received low-dose or high-dose corticosteroid therapy compared to no steroid. Results:The study period, June-August 2020, included 169 patients with COVID-19 were included and there were 39.1% female and 60.9% male with an average age of 53.1 years. The distribution of cases was as follows: high-dose 39 (23.1%), low-dose 54 (32.0%), and no steroid 76 (45.5%). Of all the patients, Intensive Care Unit (ICU) admission was for 31 (18.3%), nine (5.3%) required intubation, and 52 (30.8%) had no comorbidities. There is no difference in the mean age between the different groups. However, those being treated with steroid were more likely to have a high SOFA score (0.37 ± 0.68, 0.36 ± 0.67 and 0.04 ± 0.34, for low-dose, high-dose steroid and no steroid groups, respectively (p = 0.001). Cox regression was not possible as the mortality rate was very low (3/169; 1.78%) and none of the multivariate methods would be possible. However, there was a significant difference in the hospital LOS and the ICU LOS. Conclusion:Cox regression was not possible as the mortality rate was very low (1.78%) and none of the multivariate methods would be possible as the model will not converge. However, in t-test only, intubation was associated risk of mortality.

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Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcome of Low and High Corticosteroids in Admitted COVID-19 Patients

AlBahrani¹,

Al‐Tawfiq²,

Jebakumar³

et al. 2021

JEGH

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show abstract

“…Despite greater risk of adverse events, delayed viral shedding, and mortality, when compared to standard doses [ 55 – 58 ], high doses of CS (up to 20 mg/day DX or 250–1000 mg/day MPS) as short pulse therapy or for longer duration (over 2–3 weeks) have been used in patients with severe COVID-19 pneumonia or acute respiratory distress syndrome (ARDS) [ 59 , 60 ], in critically ill patients [ 61 ], and to prevent severe hypoxia in low resource settings [ 62 ]. Furthermore, CS therapy can cause significant systemic metabolic effects such as hyperglycemia, hyperlipidemia, and hypertension, reduced bone matrix formation, and increased bone resorption [ 63 ].…”

Section: Corticosteroids In Covid-19 Treatmentmentioning

confidence: 99%

Double Trouble—COVID-19 and the Widespread Use of Corticosteroids: Are We Staring at an Osteonecrosis Epidemic?

Shetty

2021

JOIO

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Background A combination of immune-mediated vascular damage and routine use of systemic corticosteroid (CS) therapy in COVID-19 may significantly increase the risk and burden of osteonecrosis (ON) after COVID-19. This narrative review explores the pathogenesis, risk factors, and possible preventive and early treatment measures for ON in COVID-19. Methods For this narrative review, an extensive literature search was performed using the PubMed, Medline, and Science Direct databases from January 2000 to August 2021 for relevant articles on etiopathogenesis, epidemiology, clinical manifestations, and treatment of severe acute respiratory syndrome coronavirus (SARS-CoV) infection and steroid-induced ON (SION). Results Pathogenesis of COVID-19, utility of corticosteroids in the treatment of COVID-19, pathogenesis of SION vis-a-vis SARS-CoV infection, associated risk factors, and early diagnosis and treatment of ON following CS therapy of SARS-CoV infection were discussed. Conclusion Preliminary data of COVID-19 and similar trends from the SARS 2003 epidemic indicate that the “angiocentric” pathogenesis of SARS-CoV-2 and treatment with high-dose CS may increase the risk of ON in COVID-19 patients. Risk stratification based on CS intake during COVID-19 treatment can help identify subjects at moderate to high-risk for ON where early preventive and follow-up plans can be initiated.

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“…In COVID19 infections, administration of steroids (mostly dexamethasone and methylprednisolone) during a suspected cytokine storm when the inflammatory markers like CRP, FERRITIN, IL-6, ESR starts to rise, and lead to an increase in neutrophil to lymphocyte ratio) is therapeutically effective (Garg et al, 2021). Steroids cause a decrease in immunity in conditions like CKD, HIV, patients on immunosuppressive drugs, and uncontrolled diabetes, hence, it leads to an easy manifestation of infections like mucormycosis (Edara et al, 2020;Sharun et al, 2020). One of the major contributing factors to COVID19 Associated mucormycosis is the use of Corticosteroids like glucocorticoids, which is generally administered in COVID19 patients in order to lower immune response especially during cytokine storms (Garg et al, 2021; Guideline for Management of n.d.).…”

Section: Diagnosis and Treatment Of Diseasementioning

confidence: 99%

The rise in cases of mucormycosis, candidiasis and aspergillosis amidst COVID19

Ghosh¹,

Sarkar²,

Paul³

et al. 2021

Fungal Biology Reviews

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High Dose Steroid Therapy to Prevent Severe Hypoxia in COVID-19 Patients: A Potential Solution for Low Resource Clinical Setting

Cited by 6 publications

References 15 publications

Clinical Features and Outcome of Low and High Corticosteroids in Admitted COVID-19 Patients

Clinical Features and Outcome of Low and High Corticosteroids in Admitted COVID-19 Patients

Double Trouble—COVID-19 and the Widespread Use of Corticosteroids: Are We Staring at an Osteonecrosis Epidemic?

The rise in cases of mucormycosis, candidiasis and aspergillosis amidst COVID19

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