Impact of Corticosteroids and Anticoagulant Combined Treatment on Patients Affected by COVID-19 Pneumonia

Abstract

Background:The pathogenesis of novel coronavirus disease (COVID-19) includes virus-induced systemic endothelial dysfunction, cytokine storm, and complement cascade hyperactivation, creating massive inflammatory and pro-coagulative states with diffuse vascular thrombosis. Objective: Our observational cohort study analyzed the effectiveness of corticosteroids and anticoagulant combined treatment in patients affected by COVID-19. Design and patients: 423 patients were retrospectively included in the analysis. Patients were divided into four groups: Group 1 (G1, n = 135): No treated; group 2 (G2, n = 8): Treated by methylprednisolone; group 3 (G3, n = 214): Those received low-molecular-weight heparin (LMWH); group 4 (G4, n = 66): Patients treated with combined methylprednisolone plus LMWH. The study outcome was the treatment failure, defined as all-cause of death or Intensive Care Unit (ICU) admission.Results: Mortality and ICU admission rates were 20.6% and 15.1%, respectively. The per-group analysis showed an increased prognosis for G3 (HR 0.59, 95%CI 0.36-0.95, p = 0.03) and G4 (HR 0.47, 95%CI 0.27-0.82, p = 0.007) vs. non-treated group (G1). Combined therapy was especially successful in those patients with the worst respiratory function (SpO 2 / FiO 2 ratio ≤ 220) (HR 0.43, 95%CI 0.24-0.77, p = 0.004). Conclusions:LMWH treatment alone and/or in combination with methylprednisolone seems to be associated with a better outcome, reducing the rate of treatment failure in patients affected by COVID-19 pneumonia.