Patients With A High-Risk Common Type COVID-19 Pneumonia May Be the Optimal Time for Methylprednisolone Therapy: A Retrospective Cohort Study

Abstract

Background: The optimal timing of corticosteroid treatment for coronavirus disease 2019(COVID-19) pneumonia is uncertain. We evaluated the clinical outcomes of methylprednisolone therapy (MPT) for patients with a high-risk common type(HRCT) COVID-19 pneumonia. Methods: We conducted a multi-centre retrospective cohort study in northeast China. A comparison was performed between the standard treatment (SDT) group and the SDT+MPT group to determine the efficacy of methylprednisolone in treating HRCT COVID-19 pneumonia. Results: We collected the medical records of 403 patients with HRCT COVID-19 pneumonia (127 in the SDT+MPT group and 276 in the SDT group). None of the patients had received mechanical ventilation or died. Further, there had been no side-effects associated with of MPT. Patients in the SDT+MPT group treated with methylprednisolone received an intravenous injection for a median interval of five days (interquartile range of three to seven days). The trends in lymphocyte count, C-reactive protein, interleukin 6, lactic acid dehydrogenase, respiratory rate, SpO2, PaO2, D-dimer and body temperature were similar between the SDT+MPT and SDT groups. The results for the SDT+MPT group seems to be faster improved than the SDT group; however, the results were not statistically significant. Clinical outcomes revealed that the average hospitalisation days and the rate of progression to severe type COVID-19 pneumonia in both the SDT+MPT group and the SDT group were present in 14.56±0.57days vs 16.55±0.3days(p=0.0009) and 21.26%(27/127) vs 32.4%(89/276)(p=0.0254), respectively. The 16-day nucleic acid negative rate was higher in the SDT+MPT group than the SDT group, 81.73% (104/127) vs 65.27% (180/276) (p = 0.0014). Conclusions: MPT effectively prevents patients with HRCT COVID-19 pneumonia from progressing to the severe stage. Therefore, patients with HRCT may be the optimal timing for MPT.Funding Statement: 1.The National Key Laboratory of Sponsored by Open Project of State Key Laboratory of Respiratory Disease (Project Funding Number：SKLRD-OP-201902)” 2.The National Key Laboratory of Urban Water Resources and Water Environment Full Funds. (Project Funding Number：ESK201602.)Declaration of Interests: We have not any conflict of interests to declare.Ethics Approval Statement: Ethical approval by the institutional ethics board of the Qun'li branch of the First Affiliated Hospital of Harbin Medical University and Kang'an Hospital of Mudanjiang was obtained for the analysis and summary of clinical data from COVID-19-infected inpatients.