Abstract
Background: As COVID-19 has neither a standard treatment protocol nor guidelines, there are many treatment protocols for anti-inflammatory corticosteroids and anti-coagulations for severe COVID-19 pneumonia patients. This study aimed to assess the most suitable modality in this high-risk group. Methods: A prospective, experimental study design was adopted that included 123 severe COVID-19 pneumonia patients admitted at Assiut University Hospital. Patients were divided into three groups according to a combined corticosteroid and anticoagulants therapy protocol. Group A included 32 patients, group B included 45 patients, and group C included 46 patients. Assessment of cases was conducted according to the treatment type and duration, weaning duration from oxygen therapy, length of hospital and ICU stay, and complications during treatment. Three months follow-up after discharge was performed. Results: the three patient groups showed significant differences regarding the 3-month outcome, whereas Group C showed the highest cure rate, lowest lung fibrosis, and lowest mortality rate over the other two groups. The in-hospital outcome, the development of pulmonary embolism, bleeding, hematoma, acute kidney disease, and myocardial infarction showed a significant difference between groups (p values < 0.05). Mortality predictors among severe COVID-19 patients by multivariable Cox hazard regression included treatment modality, history of comorbid diseases, increased C reactive protein, high neutrophil-lymphocyte ratio, and shorter ICU and hospital stay. Conclusion: the use of combined methylprednisolone and therapeutic Enoxaparin, according to a flexible protocol for COVID-19 patients with severe pneumonia, had two benefits; the prevention of disease complications and improved clinical outcome.
Highlights
COVID-19 was first isolated in Wuhan, China, in December 2019 [1]
Patients were diagnosed as having COVID-19 by both chest imaging, to confirm lung involvement 9X ray and computed tomography [CT] chest)and reverse-transcriptase polymerase chain reaction (RT-PCR) test [7]
A total of 123 severe COVID-19 pneumonia patients were recruited in this study and divided into three groups; group A included 32 patients, group B included patients, and group C included patients
Summary
COVID-19 was first isolated in Wuhan, China, in December 2019 [1]. It was declared by the WHO in January 2020 as a global emergency of international concern, and, on 11 March 2020, it was announced as a global pandemic [2]. The Infectious Diseases Society of America’s (IDSA) guideline panel advised against the use of corticosteroids that were widely used in China to prevent the development of acute respiratory distress syndrome (ARDS) in patients with COVID-19 pneumonia [6]. As no standard treatment for COVID-19 has been approved, and there are many treatment protocols for anti-inflammatory corticosteroids and anti-coagulants for severe COVID19 pneumonia cases, this study aims to assess the most suitable modality in this highrisk group. Mortality predictors among severe COVID-19 patients by multivariable Cox hazard regression included treatment modality, history of comorbid diseases, increased C reactive protein, high neutrophil-lymphocyte ratio, and shorter ICU and hospital stay. Conclusion: the use of combined methylprednisolone and therapeutic Enoxaparin, according to a flexible protocol for COVID-19 patients with severe pneumonia, had two benefits; the prevention of disease complications and improved clinical outcome
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