Dexamethasone in Treatment of Comorbid SARS-CoV-2 Patients Aged over 50 Years with Lung Injury over 50 %

Aim. An efficacy assessment of steroid therapy in SARS-CoV-2 patients aged over 50 years with lung damage over 50 % (grade 3–4).

Materials and methods. A retrospective study of 158 SARS-CoV-2 patients hospitalised in April—June 2020 was conducted under the inclusion criteria: age over 50 years, chest computed tomography (CT) for COVID-19-asso-ciated pneumonia, C-reactive protein (CRP) >50 mg/L, anticoagulant therapy, no contraindications to steroids, no biologic therapy. Cohort 1 patients (n = 96) received dexamethasone 4–12 mg/day, cohort 2 (n = 62) — a standard non-dexamethasone therapy.

Results. Dexamethasone treatment associated with a significant alleviation of COVID-19-associated pneumonia in CT score (p = 0.001), reduced fibrinogen (p = 0.001), a trend to CRP reduction by day 8–10 and lower demand for oxygen therapy, including ventilatory support (p = 0.001). Mortality rate was 19.8 and 75.8 % in cohorts 1 and 2, respectively (p = 0.001).

Conclusion. Dexamethasone therapy 4–12 mg/day in SARS-CoV-2 patients aged 50+ years with grade 3–4 CT changes receiving LMWH from start of hospitalisation significantly improved CT scores and reduced mortality.

1. Clinical management of COVID-19. WHO/2019-nCoV/clinical/2020.5 Available from: https://www.who.int/ publications/i/item/clinical-management-of-covid-19 (ac-cessed 15.03.2021).

2. Lin L., Lu L., Cao W., Li T. Hypothesis for potential pathogenesis of SARS-CoV-2 infection-a review of immune changes in patients with viral pneumo-nia. Emerg Microbes Infect. 2020;9(1):727–32. DOI: 10.1080/22221751.2020.1746199

3. Pedersen S., Ho Y. SARS-CoV-2: a storm is raging. J Clin Invest. 2020;130(5):2202–5. DOI: 10.1172/JCI137647

4. Sekine Т., Perez-Potti А., Rivera-Ballesteros О., Strålin K., Sekine T., Gorin J. Robust T cell immunity in convalescent individuals with asymptomatic or mild COVID-19. Cell. 2020;S0092-8674(20):31008–4. DOI: 10.1016/j.cell.2020.08.017

5. Ruscitti P., Berardicurti O., Iagnocco A., Giacome-lli R. Cytokine storm syndrome in severe COVID-19 Au-toimmun Rev. 2020;19(7):102562. DOI: 10.1016/j.aut-rev.2020.102562

6. https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1 (accessed 15.03.2021).

7. Horby P., Lim W., Emberson J. Low-cost dexamethasone reduces death by up to one third in hospitalized patients with severe respiratory complications of COVID-19 (RECOV-ERY Trial) Oxford University News Release. N Engl J Med 2020;NEJMoa2021436. DOI: 10.1056/NEJMoa2021436

8. van Paassen J., Vos J.S., Hoekstra E.M., Neu-mann K.M.I., Boot P.C., Arbous S.M. Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes. Crit Care. 2020;24(1):696. DOI: 10.1186/s13054-020-03400-9

9. Sarkar S., Khanna P., Soni K.D. Are the steroids a blan-ket solution for COVID-19? A systematic review and meta-analysis. J Med Virol. 2020;1–10. DOI: 10.1002/jmv.26483

10. Tlayjeh H., Mhish O.H., Enani M.A. Association of cor-ticosteroids use and outcomes in COVID-19 patients: a sys-tematic review and meta-analysis. Journal of Infection and Public Health. 2020;13(11):1652–63. DOI: 10.1016/j.jiph.2020.09.008

11. Coronavirus disease (COVID-19) pandemic. URL: www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance (accessed 15.06.2020).

12. Wang D., Hu B., Hu C. Clinical characteristics of 138 hospitalized patients with 2019 novelcoronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–69. DOI: 10.1001/jama.2020.1585. PMID: 32031570

13. Ivaschkin V.T., Zolnikova О.Yu., Svistunov A.A., Dzhakhaya N.L., Potskhverashvili N.D., Kokina N.I., et al. Corticosteroids in the treatment of SARS-CoV-2 related lung disease. Seche nov Medical Journal. 2020;11(2):19–28 (In Russ.). DOI: 10.47093/2218-7332.2020.11.2

14. Kogan E.A., Berezovskii Yu.S., Protsenko D.D., et al. Patologicheskaya anatomiya infektsii, vyzvannoi SARS-CoV-2. Sudebnaya meditsina.2020;6(2):8–30 (In Russ.). DOI: 10.19048/2411-8729-2020-6-2-8-30