Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational study
Critically ill patients with coronavirus diseases 2019 (COVID-19) are of grave concern. Those patients usually underwent a stage of excessive inflammation before developing acute respiratory distress syndrome. In this study, we test the hypothesis that short-term, low-to-moderate-dose corticosteroid...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2020-01-01
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| Series: | Emerging Microbes and Infections |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/22221751.2020.1807885 |
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| author | Yang Li Xian Zhou Tao Li Shiji Chan Yiqi Yu Jing-Wen Ai Haocheng Zhang Feng Sun Qiran Zhang Lei Zhu Lingyun Shao Bin Xu Wenhong Zhang |
| author_facet | Yang Li Xian Zhou Tao Li Shiji Chan Yiqi Yu Jing-Wen Ai Haocheng Zhang Feng Sun Qiran Zhang Lei Zhu Lingyun Shao Bin Xu Wenhong Zhang |
| author_sort | Yang Li |
| collection | DOAJ |
| description | Critically ill patients with coronavirus diseases 2019 (COVID-19) are of grave concern. Those patients usually underwent a stage of excessive inflammation before developing acute respiratory distress syndrome. In this study, we test the hypothesis that short-term, low-to-moderate-dose corticosteroids would benefit patients when used in the early phase of excessive inflammation, namely, the therapeutic window. Among a Shanghai cohort and a validation cohort, we enrolled COVID-19 patients showing marked radiographic progression. Short-term, low-to-moderate-dose corticosteroids were considered for them. After identifying the possible markers for the therapeutic window, we then divided the patients, based on whether they were treated with corticosteroids within the therapeutic window, into the early-start group and control group. We identified that the therapeutic window for corticosteroids was characterized by a marked radiographic progression and lactase dehydrogenase (LDH) less than two times the upper limit of normal (ULN). The Shanghai cohort comprised of 68 patients, including 47 in the early-start group and 21 in the control group. The proportion of patients requiring invasive mechanical ventilation was significantly lower in the early-start group than in the control group (10.6% vs. 33.3%, difference, 22.7%, 95% confidence interval 2.6–44.8%). Among the validation cohort of 51 patients, similar difference of the primary outcome was observed (45.0% vs. 74.2%, P = 0.035). Among COVID-19 patients with marked radiologic progression, short-term, low-to-moderate-dose corticosteroids benefits patients with LDH levels of less than two times the ULN, who may be in the early phase of excessive inflammation. |
| format | Article |
| id | doaj-art-cfec883f58f741d8ad398df8cd405bf7 |
| institution | OA Journals |
| issn | 2222-1751 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Emerging Microbes and Infections |
| spelling | doaj-art-cfec883f58f741d8ad398df8cd405bf72025-08-20T02:26:37ZengTaylor & Francis GroupEmerging Microbes and Infections2222-17512020-01-01911869187710.1080/22221751.2020.1807885Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational studyYang Li0Xian Zhou1Tao Li2Shiji Chan3Yiqi Yu4Jing-Wen Ai5Haocheng Zhang6Feng Sun7Qiran Zhang8Lei Zhu9Lingyun Shao10Bin Xu11Wenhong Zhang12Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaDepartments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaDepartment of Tuberculosis, Shanghai Public Health Clinical Center, Fudan University, Shanghai, People’s Republic of ChinaDepartment of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, People’s Republic of ChinaDepartments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaDepartments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaDepartments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaDepartments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaDepartments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaDepartments of Respiratory Diseases, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of ChinaDepartments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaDepartments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaDepartments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, People’s Republic of ChinaCritically ill patients with coronavirus diseases 2019 (COVID-19) are of grave concern. Those patients usually underwent a stage of excessive inflammation before developing acute respiratory distress syndrome. In this study, we test the hypothesis that short-term, low-to-moderate-dose corticosteroids would benefit patients when used in the early phase of excessive inflammation, namely, the therapeutic window. Among a Shanghai cohort and a validation cohort, we enrolled COVID-19 patients showing marked radiographic progression. Short-term, low-to-moderate-dose corticosteroids were considered for them. After identifying the possible markers for the therapeutic window, we then divided the patients, based on whether they were treated with corticosteroids within the therapeutic window, into the early-start group and control group. We identified that the therapeutic window for corticosteroids was characterized by a marked radiographic progression and lactase dehydrogenase (LDH) less than two times the upper limit of normal (ULN). The Shanghai cohort comprised of 68 patients, including 47 in the early-start group and 21 in the control group. The proportion of patients requiring invasive mechanical ventilation was significantly lower in the early-start group than in the control group (10.6% vs. 33.3%, difference, 22.7%, 95% confidence interval 2.6–44.8%). Among the validation cohort of 51 patients, similar difference of the primary outcome was observed (45.0% vs. 74.2%, P = 0.035). Among COVID-19 patients with marked radiologic progression, short-term, low-to-moderate-dose corticosteroids benefits patients with LDH levels of less than two times the ULN, who may be in the early phase of excessive inflammation.https://www.tandfonline.com/doi/10.1080/22221751.2020.1807885COVID-19corticosteroidsSARS-CoV-2 |
| spellingShingle | Yang Li Xian Zhou Tao Li Shiji Chan Yiqi Yu Jing-Wen Ai Haocheng Zhang Feng Sun Qiran Zhang Lei Zhu Lingyun Shao Bin Xu Wenhong Zhang Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational study Emerging Microbes and Infections COVID-19 corticosteroids SARS-CoV-2 |
| title | Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational study |
| title_full | Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational study |
| title_fullStr | Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational study |
| title_full_unstemmed | Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational study |
| title_short | Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational study |
| title_sort | corticosteroid prevents covid 19 progression within its therapeutic window a multicentre proof of concept observational study |
| topic | COVID-19 corticosteroids SARS-CoV-2 |
| url | https://www.tandfonline.com/doi/10.1080/22221751.2020.1807885 |
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