ABSTRACT
Introduction: The use of immunosuppression in patients with severe COVID has been recommended as the standard of care. However, it's use in concomitant bacterial sepsis could result in adverse outcomes. Aim(s): We analyzed the use of immunosuppression in the form of corticosteroids among patients who succumbed to COVID 19. Method(s): Patients died with COVID 19 at the intensive care unit (ICU), National Hospital, Kandy, Sri Lanka from 01.01.2021 to 31.12.2021 were retrospectively studied. Result(s): 79 deaths were analyzed. Majority were males (46/79);median age was 63 years (19, 94). The mean hospital and ICU stay were 11 days (interquartile range-IQR:7,14), 7days (IQR: 2.5,9) subsequently. 75/79 received corticosteroids, Dexamethasone(n=55), Methyl Prednisolone-MPP(n=9), Prednisolone(n=12) had been used either as a single or sequential therapy. The median daily dose and median duration were as follows. Dexamethasone: 6mg (2,10)- 7 days (1,18), MPP 750mg (500,1000)-3days (2,3), Prednisolone: 30mg (5,40)-2days (1,10). 25/46 demonstrated bacterial co-infection either with PCT>1 or blood or urine culture positivity. 24/25 with sepsis received Dexamethasone. One of them received MPP and Dexamethasone sequentially. Conclusion(s): Higher proportion of patients with bacterial co-infection were concomitantly treated with higher doses of corticosteroids,which could resulted in the adverse outcome.