Use of corticosteroid hormones in patients with moderate COVID-19: what goals can be achieved

Abstract

BACKGROUND: There is strong evidence of the effectiveness of glucocorticoids (dexamethasone) in the treatment of critically ill patients with COVID-19. However, the condition of most of them, at the time of hospitalization, is not assessed as severe or critical, but at the same time, with dynamic observation, it may worsen. It is in this group of patients that data on the effectiveness of glucocorticoids use remain few and contradictory.
 AIMS: to study the relationship between the use of a short course of corticosteroid hormones (CSH) in recommended doses and clinical and laboratory parameters of generalized inflammation in patients with a moderate course of new coronavirus infection (COVID-19) in a hospital setting.
 MATERIALS AND METHODS: The study included 121 patients with probable (clinically confirmed) and confirmed (laboratory) cases of COVID-19. A retrospective analysis of the data of electronic medical records of all patients admitted sequentially from October 1, 2020 to January 31, 2021 was carried out. The demographic indicators, comorbidities, symptoms, clinical indicators, results of laboratory tests and computed tomography were studied. Statistical analysis was performed using the standard Statistica 10 software for Windows.
 RESULTS: The data of electronic medical records of 121 patients were studied. Glucocorticoids were prescribed to 71 patients (58.7%), most often dexamethasone was used 70 out of 71 (98.5%). 73 (60.3%) patients had concomitant chronic diseases. 114 (94.2%) were discharged with recovery. patients, died ― 5 (4.1%), the cause of deaths was multiple organ failure. When evaluating groups of patients, in the period before the appointment of glucocorticoids and a similar period of illness in those who did not receive glucocorticoids significant differences were found in the groups in terms of generalized inflammation (body temperature, C-reactive protein concentration), indicators of respiratory disorders (respiration rate, oxygen saturation), according to indicators of the cellular composition of blood (lymphopenia and thrombocytopenia) in patients treated with glucocorticoids. After completing the course of glucocorticoids, patients showed a statistically significant increase in lymphocytes ― by 76.9%, platelets ― by 67.4%. The level of C-reactive protein significantly decreased by more than 4 times. The obtained data show a decrease in the severity of generalized inflammation, correction of the activation syndrome. acrophages, activation of bone marrow germs and positive clinical and laboratory dynamics of COVID-19.
 CONCLUSION: The study demonstrated reliable data on a decrease in the activity of generalized inflammation after the use of a short course of corticosteroid hormones in recommended doses. This led to the stabilization of the state in 53 of 71 (73%) patients and the termination of the escalation of further treatment.