Abstract
A myriad of symptoms presented by severely ill mechanically ventilated COVID-19 patients has added pressure on the caregivers to explore therapeutic options. Systemic steroids have been reported to therapeutically benefit patients, with elevated inflammatory markers, during the severe acute respiratory syndrome, and the Middle East respiratory syndrome outbreak. COVID-19 disease is characterized by inflammation of the respiratory system and acute respiratory distress syndrome. Given the lack of specific treatment for COVID-19, the current study aimed to evaluate the therapeutic benefit of methylprednisolone as an add-on treatment for mechanically ventilated hospitalized COVID-19 patients with severe COVID pneumonia. Data were collected retrospectively from the electronic patient medical records, and interrater reliability was determined to limit selection bias. Descriptive and inferential statistical methods were used to analyze the data. The variables were cross-tabulated with the clinical outcome, and the chi-square test was used to determine the association between the outcomes and other independent variables. Sixty-one percent (43/70) of the COVID-19 ARDS patients received standard supportive care, and the remainder were administered, methylprednisolone (minimum 40 mg daily to a maximum 40 mg q 6 h). A 28-day all-cause mortality rate, in the methylprednisolone group, was 18% (5/27, p < 0.01) significantly lower, compared to the group receiving standard supportive care (51%, 22/43). The median number of days, for the hospital length of stay (18 days), ICU length of stay (9.5 days), and the number of days intubated (6 days) for the methylprednisolone-treated group, was significantly lower (p < 0.01) when compared with the standard supportive care group. Methylprednisolone treatment also reduced the C-reactive protein levels, compared to the standard care group on day 7. Our results strengthen the evidence for the role of steroids in reducing mortality, ICU length of stay, and ventilator days in mechanically ventilated COVID-19 patients with respiratory distress syndrome.
Highlights
The pandemic of a novel coronavirus-induced respiratory illness named coronavirus disease 2019 (COVID-19) has engulfed the world; the infectivity and the associated fatality have resulted in a global public health crisis and devastatedMasood Ur Rahman and Satish Chandrasekhar Nair contributed to the studyExtended author information available on the last page of the article economies [1]
The purpose of this study is to evaluate the therapeutic benefit of methylprednisolone as an add-on treatment in addition to standard supportive care for hospitalized COVID-19 patients with severe COVID pneumonia requiring mechanical ventilation
Almost eighty-two percent (22/27) of the COVID-19 Acute respiratory distress syndrome (ARDS) patients treated with methylprednisolone survived (Table 1), as compared to 49% (21/43) in the standard supportive care group
Summary
The pandemic of a novel coronavirus-induced respiratory illness named coronavirus disease 2019 (COVID-19) has engulfed the world; the infectivity and the associated fatality have resulted in a global public health crisis and devastatedMasood Ur Rahman and Satish Chandrasekhar Nair contributed to the studyExtended author information available on the last page of the article economies [1]. Methylprednisolone is a glucocorticoid used to suppress the autoimmune and inflammatory responses in rheumatic diseases and was administrated to patients during the earlier severe acute respiratory syndrome (SARS) and the Middle East. The Al Ain Hospital Intensive Care Unit (AICU) opted against steroid treatment and provided standard supportive care. The purpose of this study is to evaluate the therapeutic benefit of methylprednisolone as an add-on treatment in addition to standard supportive care for hospitalized COVID-19 patients with severe COVID pneumonia requiring mechanical ventilation. The therapeutic benefit was determined by the reduction in the 28-day all-cause mortality (primary outcome), and, the reduction in the number of days on mechanical ventilation, intensive care unit length of stay, hospital length of stay, and the levels of inflammatory markers, as secondary outcomes, in comparison to those patients that were provided standard supportive care
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