High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response

• Published in: PloS one Vol. 16; no. 1; p. e0243964
• Main Authors: López Zúñiga, Miguel Ángel, Moreno-Moral, Aida, Ocaña-Granados, Ana, Padilla-Moreno, Francisco Andrés, Castillo-Fernández, Alba María, Guillamón-Fernández, Dionisio, Ramírez-Sánchez, Carolina, Sanchez-Palop, María, Martínez-Colmenero, Justo, Pimentel-Villar, María Amparo, Blázquez-Roselló, Sara, Moreno-Sánchez, José Juan, López-Vílchez, María, Prior-Sánchez, Inmaculada, Jódar-Moreno, Rosario, López Ruz, Miguel Ángel
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28-01-2021; Public Library of Science (PLoS)
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adult; Aged; Anticoagulants; Asthma; Biology and Life Sciences; Cardiovascular diseases; Chronic obstructive pulmonary disease; Complications and side effects; Coronary artery disease; Coronaviruses; Corticoids; Corticosteroids; COVID-19; COVID-19 - drug therapy; COVID-19 - immunology; COVID-19 - mortality; Creatinine; Cytokine Release Syndrome - drug therapy; Cytokine Release Syndrome - immunology; Dexamethasone - pharmacology; Diabetes mellitus; Dimers; Dosage; Dosage and administration; Drug dosages; Drug therapy; Editing; Endocrinology; Ethical standards; Female; Ferritin; Fibrillation; Glomerular filtration rate; Health risks; Heart diseases; Hematology; HIV; Hospitalization; Hospitals; Human immunodeficiency virus; Humans; Hypertension; Hypoxia; Immunoglobulins; Infectious diseases; Inflammation; Inflammation - immunology; Inflammation - prevention & control; Inflammatory response; Intensive care; Interleukin; Interleukin 6; Internal medicine; Kinases; L-Lactate dehydrogenase; Laboratories; Laboratory tests; Lactate dehydrogenase; Lactic acid; Lung diseases; Male; Medicine; Medicine and Health Sciences; Methylprednisolone - pharmacology; Middle Aged; Mortality; Obstructive lung disease; Otolaryngology; Patient outcomes; Patients; Physical Sciences; Prospective Studies; Prothrombin; Public health; SARS-CoV-2 - isolation & purification; Serology; Severe acute respiratory syndrome coronavirus 2; Spain - epidemiology; Survival; Survival Rate; Therapy; Thromboplastin; Triglycerides; Tumors; Viral diseases; Viral infections; Viruses; Vitamin D; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0243964

Test whether high dose corticosteroid pulse therapy (HDCPT) with either methylprednisolone or dexamethasone is associated with increased survival in COVID-19 patients at risk of hyper-inflammatory response. Provide some initial diagnostic criteria using laboratory markers to stratify these patients.
This is a prospective observational study, 318 met the inclusion criteria. 64 patients (20.1%) were treated with HDCPT by using at least 1.5mg/kg/24h of methylprednisolone or dexamethasone equivalent. A multivariate Cox regression (controlling for co-morbidities and other therapies) was carried out to determine whether HDCPT (among other interventions) was associated with decreased mortality. We also carried out a 30-day time course analysis of laboratory markers between survivors and non-survivors, to identify potential markers for patient stratification.
HDCPT showed a statistically significant decrease in mortality (HR = 0.087 [95% CI 0.021-0.36]; P < 0.001). 30-day time course analysis of laboratory marker tests showed marked differences in pro-inflammatory markers between survivors and non-survivors. As diagnostic criteria to define the patients at risk of developing a COVID-19 hyper-inflammatory response, we propose the following parameters (IL-6 > = 40 pg/ml, and/or two of the following: C-reactive protein > = 100 mg/L, D-dimer > = 1000 ng/ml, ferritin > = 500 ng/ml and lactate dehydrogenase > = 300 U/L).
HDCPT can be an effective intervention to increase COVID-19 survival rates in patients at risk of developing a COVID-19 hyper-inflammatory response, laboratory marker tests can be used to stratify these patients who should be given HDCPT. This study is not a randomized clinical trial (RCT). Future RCTs should be carried out to confirm the efficacy of HDCPT to increase the survival rates of COVID-19.