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The Role And Efficacy of High-Dose Steroid Therapy In COVID-19 Pneumonia: Insights From The Literature Along With An Original Research

Yıl 2025, Cilt: 1 Sayı: 1, 17 - 24, 01.05.2025

Ayperi Öztürk , Figen Öztürk Ergür , Suna Kavurgacı , Melahat Uzel Şener , Murat Yıldız

Öz

Introduction: Today, whereas hypoxemia and respiratory failure are the major challenging problems in the course of severe COVID-19 pneumonia, controlling the disease at a mild-moderate stage or stopping the inflammation by recognizing the cytokine storm early should be the most prominent goal. We aimed to reveal the clinical efficacy and safety of short-term high-dose corticosteroids in severe COVID-19.
Material and Methods: This retrospective observational study consisted of 54 patients who were given high-dose steroids (HDS, >250 mg/day methylprednisolone, 3 days.). Low-dose steroid (LDS) therapy (dexamethasone 8 mg ) was applied to all patients. The HDS group was reviewed in terms of decreasing hospital mortality and preventing fibrosis development in follow-up.
Results: During the observation period, out of 317 severe COVID-19 pneumonia hospitalized, HDS and LDS were administered to 54 and 216 patients, respectively. Higher body mass index, younger age, more oxygen need of patients at admission, and more need for advanced oxygen therapy during hospitalization were found in the HDS group (p<0.001). Furthermore, 18.5% of patients in the HDS group had need transfer to the intensive care unit whereas it was 3.8% in LDS (p<0.001). Additionally, the mortality rate was determined higher in the HDS group (25. 9% vs 9.9%, p<0.001). The HDS group had lower saturated O2 [IQR, 85% (76-89), p <0.001], and higher ferritin at admission. It was found that HDS was given simultaneously with the increased ferritin with deepening lymphopenia on the third and fifth days. There was no difference in fibrosis development between HDS patients receive and not (15.4% vs 26.2%, p=0.11)
Conclusion: The use of HDS in hospitalized COVID-19 patients remains unclear. The present study demonstrated that high-dose corticosteroids might not be associated with a lower mortality rate among hospitalized severe COVID-19 patients.

Anahtar Kelimeler

COVID-19 high-dose steroid methylprednisolone mortality fibrosis

Kaynakça

  • 1. COVID-19 Map. [cited october 3, 2023]. Available from: https://coronavirus.jhu.edu/ map.html
  • 2. Centers for Disease Control and Prevention CDC COVID Data Tracker. [Online]. Centers for Disease Control and Prevention. [(accessed on 26 June 2024)];2024 Available from: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
  • 3. Calabrese LH. Cytokine storm and the prospects for immunotherapy with COVID-19. Cleve Clin J Med. 2020 Jun 30;87(7):389-393. doi: 10.3949/ccjm.87a.ccc008. PMID: 32393592.
  • 4. Lam, C.W., Chan, M.H., Wong, C.K., 2004. Severe acute respiratory syndrome: clinical and laboratory manifestations. Clin. Biochem. Rev. 25, 121–132.
  • 5. The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with covid-19-preliminary report. New Engl. J. Med.2021;384:693-704. doi:10.1056/ NEJMoa2021436
  • 6. Sauñe Patricia & Bryce-Alberti, Mayte & Portmann-Baracco, Arianna & Accinelli, Roberto. (2020). Methylprednisolone pulse therapy: An alternative management of severe COVID-19. Respiratory medicine case reports. 31.101221.10.1016/j.rmcr.2020. 101221
  • 7. Bhimraj A., Morgan L., R.L Shumaker, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Published by IDSA on 3/02/2021. Last updated February 3, 2021, www.idsociety.org/COVID19guidelines.
  • 8. World Health Organization (WHO), 2020. Coronavirus Disease (COVID-19) Situation Dashboard. (Accessed June 28, 2020). https://www.who.int/emergencies/diseases/ novel-coronavirus-2019.
  • 9. Ministry of Health, General Directorate of Public Health. COVID-19 (SARS-CoV-2 Infection) Adult Patient Treatment Scientific Advisory Board Study, October 9, 2020.
  • 10. Tobaiqy M, Qashqary M, Al-Dahery S, et al. Therapeutic management of patients with COVID-19: a systematic review. Infect Prev Pract. 2020 Sep;2(3):100061. doi: 10.1016/j.infpip.2020.100061. Epub 2020 Apr 17.
  • 11. Ruiz-Irastorza G, Pijoan JI, Bereciartua E, et al. Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: an observational comparative study using routine care data. PLoS One. 2020;15(9, article e0239401):1–17. doi: 10.1371/journal.pone.0239401.
  • 12. Cusacovich I, Aparisi Á, Marcos M, et al. Corticosteroid pulses for hospitalized patients with COVID-19: effects on mortality. Mediators Inflamm 2021;2021:6637227
  • 13. Pagliano P, Scarpati G, Sellitto C, et al. Experimental Pharmacotherapy for COVID-19: The Latest Advances. J Exp Pharmacol. 2021 Jan 7;13:1-13. doi: 10.2147/JEP.S255209.
  • 14. Sun X, Wang T, Cai D, et al. Cytokine storm intervention in the early stages of COVID-19 pneumonia. Cytokine & Growth Factor Reviews. 2020;53:38–42. DOI:10.1016/j.cytogfr.2020.04.002
  • 15. Mattos-Silva, P. Felix, N. S, Silva, P. L, et al. Pros and cons of corticosteroid therapy for COVID-19 patients. Respir Physiol Neurobiol. 2020;280:103492. doi:10.1016/j.resp.2020.103492
  • 16. Kolilekas L, Loverdos K, Giannakaki S, et al. Can steroids reverse the severe COVID-19 induced ‘cytokine storm’ ? J Med Virol. 2020;92 (11):2866–2869
  • 17. So C, Ro S, Murakami M, Imai R, Jinta T. High-dose, short-term corticosteroids for ARDS caused by COVID-19: a case series. Respirol Case Rep. 2020;8(6):e00596. Published 2020 Jun 4. doi:10.1002/rcr2.596
  • 18. Chen Q, Song Y, Wang L, et al. Corticosteroids treatment in severe patients with COVID-19: a propensity score matching study [published online ahead of print, 2021 Feb 1]. Expert Rev Respir Med. 2021;1-10. doi:10.1080/17476348.2021.1856659
  • 19. Conti P, Ronconi G, Caraffa A, et al. Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies. J Biol Regul Homeost Agents. 2020 March-April,;34(2):327-331. doi: 10.23812/CONTI-E.
  • 20. Shang L, Zhao J, Hu Y, Du R, Cao B. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet. 2020;395(10225):683-684. doi:10.1016/S0140-6736(20)30361-5
  • 21. Dai J, Xiong Y, Li H, et al. Corticosteroid treatment in severe COVID-19 pneumonia: two cases and literature review. Clin Rheumatol. 2020;39(7):2031–2037
  • 22. Veronese N, Demurtas J, Yang L, et al. Use of corticosteroids in coronavirus disease 2019 pneumonia: a systematic review of the literature. Front Med (Lausanne). 2020;7:170.
  • 23. Ho JC, Ooi GC, Mok TY, et al. High– Dose Pulse Versus Nonpulse Corticosteroid Regimens in Severe Acute Respiratory Syndrome. American Journal of Respiratory and Critical Care Medicine. 2003;168(12):1449–56. DOI: 10.1164/rccm.200306-766OC
  • 24. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395(10223):473–475.
  • 25. Eraslan BZ, Fidan A, Baysal T, Cömert SS, Kıral N, Parmaksız ET. Effect of pulse methylprednisolone on prognosis in SARS-CoV-2 patients with severe pneumonia. Eur Rev Med Pharmacol Sci. 2024 Feb;28(3):1234-1240. doi: 10.26355/eurrev_202402_ 35362. PMI17)
  • 26. Edalatifard M, Akhtari M, Salehi M, et al. Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: re sults from a randomised controlled clinical trial. Eur Respir J 2020; 56: 2002808.
  • 27. Pinzón MA, Ortiz S, Holguín H, et al. Dexamethasone vs methylprednisolone high dose for Covid-19 pneumonia. PLoS One 2021; 16: e0252057.D: 38375729.
  • 28. Bartoletti M, Marconi L, Scudeller L, et al, PREDICO Study Group. Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study. Clin Microbiol Infect. 2021 Jan;27(1):105-111. doi: 10.1016/j.cmi.2020.09.014. Epub 2020 Sep 22. PMID: 32971254; PMCID: PMC7506332.
  • 29. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934–943. doi:10.1001/ jamainternmed .2020. 0994
  • 30. Bhaskar S, Sinha A, Banach M, et al. Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper. Front Immunol. 2020 Jul 10;11:1648. doi: 10.3389/fimmu.2020.01648. PMID: 32754159; PMCID: PMC7365905.

Yıl 2025, Cilt: 1 Sayı: 1, 17 - 24, 01.05.2025

Ayperi Öztürk , Figen Öztürk Ergür , Suna Kavurgacı , Melahat Uzel Şener , Murat Yıldız

Öz

Kaynakça

  • 1. COVID-19 Map. [cited october 3, 2023]. Available from: https://coronavirus.jhu.edu/ map.html
  • 2. Centers for Disease Control and Prevention CDC COVID Data Tracker. [Online]. Centers for Disease Control and Prevention. [(accessed on 26 June 2024)];2024 Available from: https://covid.cdc.gov/covid-data-tracker/#variant-proportions
  • 3. Calabrese LH. Cytokine storm and the prospects for immunotherapy with COVID-19. Cleve Clin J Med. 2020 Jun 30;87(7):389-393. doi: 10.3949/ccjm.87a.ccc008. PMID: 32393592.
  • 4. Lam, C.W., Chan, M.H., Wong, C.K., 2004. Severe acute respiratory syndrome: clinical and laboratory manifestations. Clin. Biochem. Rev. 25, 121–132.
  • 5. The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with covid-19-preliminary report. New Engl. J. Med.2021;384:693-704. doi:10.1056/ NEJMoa2021436
  • 6. Sauñe Patricia & Bryce-Alberti, Mayte & Portmann-Baracco, Arianna & Accinelli, Roberto. (2020). Methylprednisolone pulse therapy: An alternative management of severe COVID-19. Respiratory medicine case reports. 31.101221.10.1016/j.rmcr.2020. 101221
  • 7. Bhimraj A., Morgan L., R.L Shumaker, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Published by IDSA on 3/02/2021. Last updated February 3, 2021, www.idsociety.org/COVID19guidelines.
  • 8. World Health Organization (WHO), 2020. Coronavirus Disease (COVID-19) Situation Dashboard. (Accessed June 28, 2020). https://www.who.int/emergencies/diseases/ novel-coronavirus-2019.
  • 9. Ministry of Health, General Directorate of Public Health. COVID-19 (SARS-CoV-2 Infection) Adult Patient Treatment Scientific Advisory Board Study, October 9, 2020.
  • 10. Tobaiqy M, Qashqary M, Al-Dahery S, et al. Therapeutic management of patients with COVID-19: a systematic review. Infect Prev Pract. 2020 Sep;2(3):100061. doi: 10.1016/j.infpip.2020.100061. Epub 2020 Apr 17.
  • 11. Ruiz-Irastorza G, Pijoan JI, Bereciartua E, et al. Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: an observational comparative study using routine care data. PLoS One. 2020;15(9, article e0239401):1–17. doi: 10.1371/journal.pone.0239401.
  • 12. Cusacovich I, Aparisi Á, Marcos M, et al. Corticosteroid pulses for hospitalized patients with COVID-19: effects on mortality. Mediators Inflamm 2021;2021:6637227
  • 13. Pagliano P, Scarpati G, Sellitto C, et al. Experimental Pharmacotherapy for COVID-19: The Latest Advances. J Exp Pharmacol. 2021 Jan 7;13:1-13. doi: 10.2147/JEP.S255209.
  • 14. Sun X, Wang T, Cai D, et al. Cytokine storm intervention in the early stages of COVID-19 pneumonia. Cytokine & Growth Factor Reviews. 2020;53:38–42. DOI:10.1016/j.cytogfr.2020.04.002
  • 15. Mattos-Silva, P. Felix, N. S, Silva, P. L, et al. Pros and cons of corticosteroid therapy for COVID-19 patients. Respir Physiol Neurobiol. 2020;280:103492. doi:10.1016/j.resp.2020.103492
  • 16. Kolilekas L, Loverdos K, Giannakaki S, et al. Can steroids reverse the severe COVID-19 induced ‘cytokine storm’ ? J Med Virol. 2020;92 (11):2866–2869
  • 17. So C, Ro S, Murakami M, Imai R, Jinta T. High-dose, short-term corticosteroids for ARDS caused by COVID-19: a case series. Respirol Case Rep. 2020;8(6):e00596. Published 2020 Jun 4. doi:10.1002/rcr2.596
  • 18. Chen Q, Song Y, Wang L, et al. Corticosteroids treatment in severe patients with COVID-19: a propensity score matching study [published online ahead of print, 2021 Feb 1]. Expert Rev Respir Med. 2021;1-10. doi:10.1080/17476348.2021.1856659
  • 19. Conti P, Ronconi G, Caraffa A, et al. Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies. J Biol Regul Homeost Agents. 2020 March-April,;34(2):327-331. doi: 10.23812/CONTI-E.
  • 20. Shang L, Zhao J, Hu Y, Du R, Cao B. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet. 2020;395(10225):683-684. doi:10.1016/S0140-6736(20)30361-5
  • 21. Dai J, Xiong Y, Li H, et al. Corticosteroid treatment in severe COVID-19 pneumonia: two cases and literature review. Clin Rheumatol. 2020;39(7):2031–2037
  • 22. Veronese N, Demurtas J, Yang L, et al. Use of corticosteroids in coronavirus disease 2019 pneumonia: a systematic review of the literature. Front Med (Lausanne). 2020;7:170.
  • 23. Ho JC, Ooi GC, Mok TY, et al. High– Dose Pulse Versus Nonpulse Corticosteroid Regimens in Severe Acute Respiratory Syndrome. American Journal of Respiratory and Critical Care Medicine. 2003;168(12):1449–56. DOI: 10.1164/rccm.200306-766OC
  • 24. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395(10223):473–475.
  • 25. Eraslan BZ, Fidan A, Baysal T, Cömert SS, Kıral N, Parmaksız ET. Effect of pulse methylprednisolone on prognosis in SARS-CoV-2 patients with severe pneumonia. Eur Rev Med Pharmacol Sci. 2024 Feb;28(3):1234-1240. doi: 10.26355/eurrev_202402_ 35362. PMI17)
  • 26. Edalatifard M, Akhtari M, Salehi M, et al. Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: re sults from a randomised controlled clinical trial. Eur Respir J 2020; 56: 2002808.
  • 27. Pinzón MA, Ortiz S, Holguín H, et al. Dexamethasone vs methylprednisolone high dose for Covid-19 pneumonia. PLoS One 2021; 16: e0252057.D: 38375729.
  • 28. Bartoletti M, Marconi L, Scudeller L, et al, PREDICO Study Group. Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study. Clin Microbiol Infect. 2021 Jan;27(1):105-111. doi: 10.1016/j.cmi.2020.09.014. Epub 2020 Sep 22. PMID: 32971254; PMCID: PMC7506332.
  • 29. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934–943. doi:10.1001/ jamainternmed .2020. 0994
  • 30. Bhaskar S, Sinha A, Banach M, et al. Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper. Front Immunol. 2020 Jul 10;11:1648. doi: 10.3389/fimmu.2020.01648. PMID: 32754159; PMCID: PMC7365905.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Göğüs Hastalıkları
Bölüm Original Article
Yazarlar

Ayperi Öztürk 0000-0003-0692-4784

Figen Öztürk Ergür 0000-0003-1915-714X

Suna Kavurgacı 0000-0002-5856-4891

Melahat Uzel Şener 0000-0001-8309-9517

Murat Yıldız 0000-0002-9625-9994

Erken Görünüm Tarihi 28 Nisan 2025
Yayımlanma Tarihi 1 Mayıs 2025
Gönderilme Tarihi 20 Mart 2025
Kabul Tarihi 24 Mart 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 1 Sayı: 1

Kaynak Göster

Vancouver Öztürk A, Öztürk Ergür F, Kavurgacı S, Uzel Şener M, Yıldız M. The Role And Efficacy of High-Dose Steroid Therapy In COVID-19 Pneumonia: Insights From The Literature Along With An Original Research. Sanatorium Med J. 2025;1(1):17-24.
 Kapak Resmi İndir

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