Personalized corticosteroid treatment of patients with severe new coronavirus infection complicated by pneumonia: a prospective comparative study

Abstract

INTRODUCTION: A new coronavirus infection caused by the SARS-CoV-2 coronavirus and the associated disease COVID-19 is accompanied by a high incidence of acute respiratory distress syndrome (ARDS) and pneumonia with respiratory failure. Corticosteroids are a therapeutic treatment option. OBJECTIVE: To determine the advantage of personalized corticosteroid dosing to reduce inflammation in pneumonia in patients with comorbid diseases. MATERIALS AND METHODS: A prospective comparative study was conducted among adult patients in the Republican Clinical Infectious Hospital and the Clinical Emergency Hospital (Ufa, Republic of Bashkortostan) from May 2020 to May 2021. Patients were divided into two groups: personalized corticosteroid administration in accordance with the level of the inflammation biomarker C-reactive protein (CRP) (n = 30) compared with conventional therapy (n = 28). Measurements of CRP levels in blood samples were carried out at the time of hospitalization and then daily during the first 5 days of treatment. RESULTS: The intervention group had fewer days of respiratory support (9.4 [6.2–15.6] vs. 14.3 [7.1–21.4]; p = 0.003) and no differences in cumulative outcome (persistent dependence of respiratory support or death) and the incidence of nosocomial infection compared with the control group. Daily distribution of the biomarker CRP showed significantly lower levels on 2–4 days of treatment in the intervention group compared with the control group. CONCLUSIONS: In critically ill patients with pneumonia caused by COVID-19, and comorbid diseases, a personalized approach to the corticosteroids prescribing slightly reduced the frequency of treatment ineffectiveness and statistically significantly reduced the duration of respiratory support.