Acute Crit Care.  2023 Feb;38(1):57-67. 10.4266/acc.2022.00941.

Methylprednisolone pulse therapy for critically ill patients with COVID-19: a cohort study

• Choi KJ
• Jung SK
• Kim KC
• Kim EJ

• KMID: 2540315
• DOI: http://doi.org/10.4266/acc.2022.00941

Abstract

Background
The guidelines recommend the use of dexamethasone 6 mg or an equivalent dose in patients with coronavirus disease 2019 (COVID-19) who require supplemental oxygen. Given that the severity of COVID-19 varies, we investigated the effect of a pulse dose of corticosteroids on the clinical course of critically ill patients with COVID-19.
Methods
This single-center, retrospective cohort study was conducted between September and December 2021, which was when the Delta variant of the COVID-19 virus was predominant. We evaluated the mortality and oxygenation of severe to critical COVID-19 cases between groups that received dexamethasone 6 mg for 10 days (control group) and methylprednisolone 250 mg/day for 3 days (pulse group).
Results
Among 44 patients, 14 and 30 patients were treated with control steroids and pulse steroids, respectively. There was no difference in disease severity, time from COVID-19 diagnosis to steroid administration, or use of remdesivir or antibacterial agents between the two groups. The pulse steroid group showed a significant improvement in oxygenation before and after steroid treatment (P<0.001) compared with the control steroid group (P=0.196). There was no difference in in-hospital mortality (P=0.186); however, the pulse steroid group had a lower mortality rate (23.3%) than the control steroid group (42.9%). There was a significant difference in the length of hospital stay between both two groups (P=0.039).
Conclusions
Pulse steroids showed no mortality benefit but were associated with oxygenation improvement and shorter hospital stay than control steroids. Hyperglycemia should be carefully monitored with pulse steroids.

Keyword

corticosteroid; COVID-19; methylprednisolone; pulse glucocorticoid therapy

Figure

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  Figure 1. Flowchart of critical or severe COVID-19 cases with control and pulse steroid groups. COVID-19: coronavirus disease 2019; ICU: intensive care unit; ARDS: acute respiratory distress syndrome.

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  Figure 2. Changes in the acute respiratory distress syndrome (ARDS) severity of the control and pulse steroid groups, which include patients with critical or severe coronavirus disease 2019 (COVID-19) cases. ARDS severity was adopted from the Berlin definition [16]: severe, PF ratio ≤100; moderate, 100< PF ratio ≤200; mild, 200< PF ratio ≤300. PF ratio, partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio.

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  Figure 3. Changes in chest X-ray between pre- and post-steroid treatment in the pulse steroid group. (A-C) These examples were three cases of chest X-ray improvement after pulse steroid administration.

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