Corticosteroids were given because of radiological evidence of pneumonia progression (26/28) and/or unremitting fever (22/28) after admission. corticosteroid-untreated individuals were included as settings. Results: Cl-amidine At the time of admission, corticosteroid-treated individuals (= 28) experienced a more advanced baseline illness compared with corticosteroid-untreated individuals (= 44), as reflected by poorer blood laboratory guidelines (lymphocytes, C-reactive protein, and lactate dehydrogenase) and more extensive chest computed tomography (CT) abnormalities. Corticosteroids were given because of radiological evidence of pneumonia progression (26/28) and/or unremitting fever (22/28) after admission. The median time from illness onset to corticosteroid treatment was 9 days (IQR, 7C10). The median duration and accumulated dose of corticosteroid treatment were 4.5 days [interquartile range (IQR), 3C5] and 140 mg of methylprednisolone (IQR, 120C200). Intravenous immunoglobulin (20 g per day for 3C5 days) was co-administered with corticosteroids. With the corticosteroid treatment, all individuals accomplished an abatement of fever within 1 day, and 78.6% (22/28) of the individuals achieved radiological remission Cl-amidine when evaluated about 3 days later. Only one (3.6%) patient progressed to severe COVID-19, and all individuals recovered and were discharged without any sequela. The median time from illness onset to viral clearance was related, as compared with 44 corticosteroid-untreated individuals with relatively milder disease [18 (IQR 14.3C23.5) days vs. 17 (IQR, 12C20) days, = 0.252]. When modified for age, sex, underlying comorbidities, baseline blood laboratory guidelines, viral weight, and chest radiological findings, the causal risk percentage of corticosteroid treatment for the viral clearance was 0.79 (95%CI, 0.48C1.30, = 0.34). Summary: Short-course and low-dose applications of corticosteroids, when co-administered with intravenous immunoglobulin, in non-severe COVID-19 patients during the stage of clinical deterioration may possibly prevent disease progression, while having a negligible impact on the viral clearance. 0.05 is considered statistically significant. Results Characteristics of the Patients The median time from illness onset to admission was 5 days (IQR, 2C7), with no significant difference between corticosteroid group and non-corticosteroid group. At the time of admission, patients in the corticosteroid group were older, and experienced a higher percentage of patients with fever or shortness of breath, lower lymphocyte count or percentage, higher lactate dehydrogenase (LDH) level, and wider range of pulmonary involvement, compared with those in the non-corticosteroid group ( 0.05, Table 1). The serum C-reactive protein (CRP) level was also higher in the corticosteroid group, although it did not reach statistical significance (= 0.051). There were no obvious changes of liver and renal functions, or in the coagulation profile (Table 1). None of the patients had elevated cardiac troponin I level. The baseline viral weight was comparable between the corticosteroid group and non-corticosteroid group (Table 1). Table 1 Baseline demographics, clinical, laboratory, and radiological characteristics of 72 patients with COVID-19. 72)28)44)= 0.002). However, none of the 15 antibiotic-treated patients had a confirmed bacterial infection. Table 2 Treatments and outcomes for 72 patients with COVID-19. 72)28)44) 0.001, Table 3). Two patients did not have follow-up chest CT scans before corticosteroid administration to evaluate whether there was radiological progression of pneumonia. Corticosteroids were given to these two patients due to unremitting fever after admission. There was a significant increase of CRP at the time of corticosteroid administration as compared with baseline (= 0.007, Table 3). Table 3 FRP-2 Changes of laboratory and radiological characteristics in 28 corticosteroid-treated patients. = 0.252] (Table 2, Physique 1). After adjusting for age of more than 60 years, sex, any underlying disease, and baseline parameters (LDH of more than 245 IU/L, lymphocytes of 0.8 109 cells/L, CRP of more than 10 mg/L, viral weight [Ct value] and quantity of lung lobe involvement), the causal hazard ratio of corticosteroids for viral clearance was 0.79 (95%CI, 0.48C1.30, = 0.34). Of notice, patients in Cl-amidine the corticosteroid group experienced a significantly longer length of hospital stay as compared with those in the non-corticosteroid group [25 days (IQR,16.3C30) vs. 14.5 days [10C26], respectively; = 0.016, Table 2]. Open in a separate window Figure 1 Time to viral clearance in patients with COVID-19. At the time of starting corticosteroid treatment, 78.6% (22/28) of the patients had fever. The median axillary heat was 38.2C (IQR, 37.9C38.7). With corticosteroid treatment, all patients achieved an Cl-amidine abatement of fever within 1 day. However, four patients experienced transient fever ( 24 h) after corticosteroid discontinuation. When the severity of pneumonia was evaluated qualitatively, chest CT performed 2C4 days after starting corticosteroid treatment showed resolution of pneumonia in 78.6% (22/28) and progression of pneumonia in 22.4% (6/28) of the patients. For the six patients with continuing progression of pneumonia after 2C4 days of corticosteroid treatment, follow-up chest CT obtained about 3 days later showed resolution of pneumonia in five patients and stabilization of pneumonia in one patient. When the severity of pneumonia was evaluated with the semi-quantitative method, the median CT score decreased from 8 (IQR, 5.3C11) before/at the time of Cl-amidine corticosteroid.
Corticosteroids were given because of radiological evidence of pneumonia progression (26/28) and/or unremitting fever (22/28) after admission