Identification of patients with COVID-19 who are optimal for methylprednisolone pulse therapy

Shosei Ro; Naoki Nishimura; Ryosuke Imai; Yutaka Tomishima; Clara So; Manabu Murakami; Kohei Okafuji; Atsushi Kitamura; Torahiko Jinta; Tomohide Tamura

doi:10.4081/mrm.2021.781

Identification of patients with COVID-19 who are optimal for methylprednisolone pulse therapy

Authors

Shosei Ro Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo https://orcid.org/0000-0002-9271-382X
Naoki Nishimura Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo https://orcid.org/0000-0003-4727-9048
Ryosuke Imai Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo https://orcid.org/0000-0002-3129-916X
Yutaka Tomishima Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo
Clara So Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo
Manabu Murakami St. Luke’s International Hospital https://orcid.org/0000-0002-4083-083X
Kohei Okafuji Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo https://orcid.org/0000-0001-5687-5197
Atsushi Kitamura Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo https://orcid.org/0000-0003-0303-1198
Torahiko Jinta Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo
Tomohide Tamura Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Chuo-ku, Tokyo

DOI: https://doi.org/10.4081/mrm.2021.781

Keywords:

Coronavirus disease 2019, corticosteroids, pulse steroid therapy, methylprednisolone, complications

Abstract

Background: Corticosteroids have been reported to reduce the mortality rates in patients with coronavirus disease 2019 (COVID-19). Additionally, the role of high-dose methylprednisolone pulse therapy in reducing mortality in critically ill patients has also been documented. The purpose of this study is to identify patients with COVID-19 who are suitable for methylprednisolone pulse therapy.
Methods: This was a retrospective study that included patients with COVID-19 receiving methylprednisolone pulse therapy (>250 mg/day for 3 days) with subsequent tapering doses at our hospital between June 2020 and January 2021. We examined the differences in background clinical factors between the surviving group and the deceased group.
Results: Of 156 patients that received steroid therapy, 17 received methylprednisolone pulse therapy. Ten patients recovered (surviving group) and seven patients died (deceased group). The median age of the surviving and deceased groups was 64.5 years (range, 57-85) and 79 years (73-90), respectively, with a significant difference (p=0.004). Five of the deceased patients (71%) had developed serious complications associated with the cause of death, including pneumothorax, pneumomediastinum, COVID-19-associated pulmonary aspergillosis, cytomegalovirus infection, and bacteremia. On the other hand, of the 10 survivors, only one elderly person had cytomegalovirus infection and the rest recovered without complications.
Conclusion: Administration of methylprednisolone pulse therapy with subsequent tapering may be an effective treatment in patients with COVID-19 up to the age of early 70s; however, severe complications may be seen in elderly patients.

Author Biography

Manabu Murakami, St. Luke’s International Hospital

Department of Pulmonary Medicine, Thoracic Center

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