The role of methylprednisolone on preventing disease progression for hospitalized patients with severe COVID‐19

Yang, Rongrong; Xiong, Yong; Ke, Hengning; Chen, Tielong; Gao, Shicheng

BACKGROUND: COVID‐19 is a public health emergency that is spreading worldwide and seriously affecting the global economy. Data on the effectiveness and safety of the use of methylprednisolone for patients with severe COVID‐19 remain limited. METHODS: In this retrospective study, epidemiological, clinical, laboratory, treatment and outcomes data of hospitalized patients with severe COVID‐19 in Zhongnan Hospital of Wuhan University from January 1 to 7 March 2020, were collected. Binary logistic regression model was used to analyse risk factors for disease progression from severe COVID‐19 illness to critical illness. The effectiveness and safety of the use of methylprednisolone for patients with severe COVID‐19 disease were evaluated. RESULTS: The results of the multivariate analysis from 175 patients with severe COVID‐19 indicate that the use of methylprednisolone was a protective factor against disease progression from severe to critical illness(P < .001; OR: 0.054 95% CI: 0.017‐0.173). Among patients with severe COVID‐19 aged < 65 years, both the proportion of patients who progressed to critical illness (42.2% vs 90.0%, P = .000) and the mortality(6.7% vs 30.0%, P = .002) were lower for patients in methylprednisolone group, compared with those in the non‐methylprednisolone group, whereas no statistical differences between the methylprednisolone group and the non‐methylprednisolone group were found among patients with COVID‐19 older than 65 years. Moreover, both the levels of CD4(+) T lymphocyte counts (646 vs 463/µL, P = .007) and IL‐6 (241.9 vs 82.8 pg/mL, P = .025) were higher among patients with severe COVID‐19 aged < 65 years, compared with those patients ≥ 65 years old. CONCLUSION: Data from the limited sample showed that the early use of low or medium doses of methylprednisolone has a positive effect for patients with severe COVID‐19 younger than 65 years old, and excessive immune response and cytokine storm may be some of the reasons for the effectiveness.