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Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational study.
Li, Yang; Zhou, Xian; Li, Tao; Chan, Shiji; Yu, Yiqi; Ai, Jing-Wen; Zhang, Haocheng; Sun, Feng; Zhang, Qiran; Zhu, Lei; Shao, Lingyun; Xu, Bin; Zhang, Wenhong.
  • Li Y; Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
  • Zhou X; Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
  • Li T; Department of Tuberculosis, Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China.
  • Chan S; Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, People's Republic of China.
  • Yu Y; Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
  • Ai JW; Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
  • Zhang H; Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
  • Sun F; Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
  • Zhang Q; Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
  • Zhu L; Departments of Respiratory Diseases, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
  • Shao L; Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
  • Xu B; Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
  • Zhang W; Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
Emerg Microbes Infect ; 9(1): 1869-1877, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-730432
ABSTRACT
Critically ill patients with coronavirus diseases 2019 (COVID-19) are of grave concern. Those patients usually underwent a stage of excessive inflammation before developing acute respiratory distress syndrome. In this study, we test the hypothesis that short-term, low-to-moderate-dose corticosteroids would benefit patients when used in the early phase of excessive inflammation, namely, the therapeutic window. Among a Shanghai cohort and a validation cohort, we enrolled COVID-19 patients showing marked radiographic progression. Short-term, low-to-moderate-dose corticosteroids were considered for them. After identifying the possible markers for the therapeutic window, we then divided the patients, based on whether they were treated with corticosteroids within the therapeutic window, into the early-start group and control group. We identified that the therapeutic window for corticosteroids was characterized by a marked radiographic progression and lactase dehydrogenase (LDH) less than two times the upper limit of normal (ULN). The Shanghai cohort comprised of 68 patients, including 47 in the early-start group and 21 in the control group. The proportion of patients requiring invasive mechanical ventilation was significantly lower in the early-start group than in the control group (10.6% vs. 33.3%, difference, 22.7%, 95% confidence interval 2.6-44.8%). Among the validation cohort of 51 patients, similar difference of the primary outcome was observed (45.0% vs. 74.2%, P = 0.035). Among COVID-19 patients with marked radiologic progression, short-term, low-to-moderate-dose corticosteroids benefits patients with LDH levels of less than two times the ULN, who may be in the early phase of excessive inflammation.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Adrenal Cortex Hormones / Coronavirus Infections / Pandemics Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: Emerg Microbes Infect Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Adrenal Cortex Hormones / Coronavirus Infections / Pandemics Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: Emerg Microbes Infect Year: 2020 Document Type: Article