key: cord-281753-neur9nmc
authors: Ji, Jingjing; Wu, Ming; Zhong, Li; Liu, Zheying; Wang, Conglin; Shao, Ziyun; Xie, Qifeng; Liu, Zhifeng
title: Early, low-dose, short-term methylprednisolone decreased the mortality in critical COVID-19 patients: a multicenter retrospective cohort study
date: 2020-11-08
journal: J Infect
DOI: 10.1016/j.jinf.2020.11.001
sha: 
doc_id: 281753
cord_uid: neur9nmc

nan

We read with interest the recent paper by Yang et al, concluding that corticosteroids overall have a negative impact on COVID-19 outcomes from a meta-analysis 1 . Critical COVID-19, characterized by refractory hypoxemia caused by acute respiratory distress syndrome (ARDS), is a life-threatening multi-organ dysfunction syndrome resulted from host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Glucocorticoid (GC) was one of the antiinflammatory medications used in critical patients 2 . Efficacy of glucocorticoids has been reported in numerous clinical studies in the treatment of coronavirus pneumonia 3 . Yang and colleagues demonstrated that patients treated with GC had a higher mortality 1 , suggesting that not all patients could benefit from GC treatment. Present study aimed to evaluate the effect of GC on different patient population. Since critical patients were more likely to receive GC therapy, only severe type and critical type patients, according to clinical classification of the Chinese Recommendations for Diagnosis and Treatment of Novel Coronavirus (SARSCoV2) infection (Trial 7th version) 4 , were enrolled in present study. We retrospective collected the clinical and outcome data of critical COVID-19 patients, and taking methylprednisolone ( Few studies have discussed the application time, dosage and duration of MP, which were mostly based on the physician experience. To further clarify when and how to employ MP application on the critical type patients, the hazards ratios were analyzed in each group according to the starting time, dosage, and treatment duration ( Figure 2 ). In all 107 critical type patients, 33 of them were not received MP treatment, 59 of them received MP treatment in 7 days after admission to hospital and 12 of them were received after 7 days. 3 patients received MP treatment, but the starting time were missed, and they were not enrolled in analysis. Our results showed MP treatment in 7 days after admission could decrease the 60-day fatality (HR: 0.294, 95 % CI: 0.159-0.543, P-value < 0.001), while MP treatment after 7 days has no effect on the fatality. Subgroup with different doses of MP (=< 80 mg/d or > 80 mg/d) were also analyzed. We found that small dose MP showed significant effect on the fatality (HR: 0.329, 95 % CI: 0.178-0.605, p value < 0.001). In addition, most patients benefited from MP were received treatment no more than 7 days. MP long-term treatment might increase the death risk.

Present multicenter retrospective cohort study showed that methylprednisolone therapy could decrease the 60-fatality for the COVID-19 patients diagnosed as critical type, that is, those occurred respiratory failure and needs mechanical ventilation, or shock, or multiple organ failure and needs ICU monitoring. Early (starting in 7 days after admission), low-dose (no more than 80 mg/d), and short-term (no more than 7 days) methylprednisolone therapy could significant decrease the 60-day fatality. 

The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

The authors declare that they have no competing interests.

The study was approved by the Research Ethics Commission of General Hospital of Southern Theater Command of PLA.

The requirement for informed consent was waived by the Ethics Commission.

The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and metaanalysis

Glucocorticoid attenuates acute lung injury through induction of type 2 macrophage

The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China

National Health Commission of the People`s Republic of China. Chinese recommendations for diagnosis and treatment of novel coronavirus (SARSCoV2) infection (Trial 7th version)

Independent roles of macrophage migration inhibitory factor and endogenous, but not exogenous glucocorticoids in regulating leukocyte trafficking

Guidelines for the diagnosis and management of critical illnessrelated corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

Short-Term Glucocorticoid Treatment Normalizes the Microcirculatory Response to Remote Ischemic Conditioning in Early Complex Regional Pain Syndrome

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Not applicable.

All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Zhifeng Liu was responsible for study concept and 
