The impact of dexamethasone versus methylprednisolone upon neutrophil/lymphocyte ratio in COVID-19 patients admitted to ICU and its implication upon mortality

Abstract

ABSTRACT Background Up till now, there has been no definite treatment for severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). Some studies have shown favorable effects of corticosteroids on COVID-19. This study aimed to compare the effect of dexamethasone versus methylprednisolone in COVID-19 patients, and their effects upon the neutrophil/lymphocyte ratio (NLR) in correlation to mortality. Methods A randomizeddouble-blind clinical trial of 60 patients was divided into two equal groups. Group D, was delivered intravenous dexamethasone 8 mg/day for 7 days. Group M, was delivered intravenous methylprednisolone 1 mg/kg/day in 2 divided doses per day for 7 days. Inflammatory response monitoring by NLR and other markers was compared between the two groups. Results The NLR was significantly lower in the methylprednisolone group than the dexamethasone group on the 5th and 7th days (p-values of 0.014 and 0.019 respectively). The IL-6 was also significantly lower in the M than the D group on the 7th day (16.70 ± 5.5 versus 39.61 ± 8.19 with p-value 0.024). The mortality rate was significantly lower in the methylprednisolone group than dexamethasone group as well (5 versus 13 patients respectively with p-value = 0.024). The ROC curve for the NLR and its correlation to the mortality rate showed a higher area under the ROC curve in group M than in group D (0.968 versus 0.81 respectively). The optimal cut-off points were 13.25 in group D versus 10.65 in group M. Conclusions Methylprednisolone can reduce inflammatory response and mortality as reflected upon NLR and IL-6 than dexamethasone in COVID-19 patients admitted to ICU. Clinical Trials Registration Number: NCT04909918 All authors stated that the manuscript has been read and approved by all of them and that each author believes that the manuscript represents an honest work