Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data

Abstract

Objective To analyze the effects of a short course of methyl-prednisolone pulses (MP) during the second week of disease (week-2) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia. Methods Comparative observational study using data collected from routine care at Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain in patients with COVID-19 pneumonia. We compared patients who received week-2-MP (125-250 mg/d x3) with those who did not, with the end-points time to death and time to death or endotracheal intubation. Results We included 242 patients with COVID-19 pneumonia and elevated inflammatory markers at admission. Sixty-one patients (25%) received week-2-MP. Twenty-two patients (9%) died and 31 (12.8%) suffered death or intubation. The adjusted HRs for death and death or intubation for patients in the week-2-MP group were 0.35 (95%CI 0.11 to 1.06, p = 0.064) and 0.33 (95%CI 0.13 to 0.84, p = 0.020), respectively. These differences were specifically seen in the subcohort of patients with a SpO2/FiO2 at day 7 lower than 353 (adjusted HR 0.31,

Successful use of mild therapeutic hypothermia as compassionate treatment for severe refractory hypoxemia in COVID-19

“…Some authors define a hyperinflammatory state as a C-reactive protein concentration greater than 150 mg/L, ferritin concentration of greater than 1500 μg/L, or D-dimer concentration greater than 2500 mg/L [ 29 , 30 ]. Two of those criteria were present in our case, supporting a severe case of COVID-19 in the inflammatory phase [ 3 , 27 , 31 , 32 ]. In this stage of the disease, the physiologic effects of controlled hypothermia may play a role in improving gas exchange, being more intense in hyperthermic subjects [ 20 ].…”

Systematic Review on the Therapeutic Options for COVID-19: Clinical Evidence of Drug Efficacy and Implications

“… 146 Ruiz-Irastorza et al (2020) in their study involving 242 patients also showed that methylprednisolone was effective in improving respiration among 242 COVID-19 patients. 147 Rahman et al (2020) in an observational study involving 136 COVID-19 patients admitted to ICU also found that early administration of steroids improved survival and decreased ICU stay. 148 In line with this, a recent meta-analysis from the WHO rapid appraisal team reported that critically ill COVID-19 patients who received systemic corticosteroids were associated with lower mortality than placebo or usual care.…”

High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response

“…It is worth nothing that in this study we define high dose corticosteroids pulses as doses of at least 125 mg of methylprednisolone or dexamethasone equivalent. Previous studies in COVID-19 patients did not found clinical differences between methylprednisolone doses above 125 mg [ 14 , 25 , 26 ]. We also tested for low corticosteroid doses and did not find a statistically significant difference in outcome.…”