A comparison of the Effects of Low and High Doses of Corticosteroids on Recovery of the Patients with Covid-19

Samimagham, Hamid Reza; Hajiabdolrrasouli, Ladan; Salimi Asl, Ali; Khajavi Mayvan, Fatemeh; Boushehri, Elham; Arabi, Mohsen; Abbasi, Mohammad Amin; Moradi, Mohammad Reza; Kazemi Jahromi, Mitra

doi:10.52547/rabms.9.2.62

Volume 9, Issue 2 (4-2023) Journal of Research in Applied and Basic Medical Sciences 2023, 9(2): 62-70 | Back to browse issues page

‎ 10.52547/rabms.9.2.62

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Samimagham H R, Hajiabdolrrasouli L, Salimi Asl A, Khajavi Mayvan F, Boushehri E, Arabi M, et al . A comparison of the Effects of Low and High Doses of Corticosteroids on Recovery of the Patients with Covid-19. Journal of Research in Applied and Basic Medical Sciences 2023; 9 (2) :62-70
URL: http://ijrabms.umsu.ac.ir/article-1-226-en.html

A comparison of the Effects of Low and High Doses of Corticosteroids on Recovery of the Patients with Covid-19

Hamid Reza Samimagham

, Ladan Hajiabdolrrasouli

, Ali Salimi Asl

, Fatemeh Khajavi Mayvan

, Elham Boushehri

, Mohsen Arabi

, Mohammad Amin Abbasi

, Mohammad Reza Moradi

, Mitra Kazemi Jahromi ^*

Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandarabbas, Iran , mitra.kazemijahromi@gmail.com

Abstract: (782 Views)

Background & Aims: SARS-CoV-2 is a new coronavirus type that first appeared in Wuhan, China, and caused a pandemic of respiratory diseases from the end of 2019. Severe infections of this virus can cause incorrect adjustments of cytokine and chemokine responses, which ultimately causes damage to the lung tissue. Corticosteroids are a class of drugs that reduce inflammation and immune system activities in the body. For this reason, many doctors and researchers thought of using corticosteroid treatments to control the cytokine storm.
Materials & Methods: In this retrospective descriptive cross-sectional study, the files of Covid-19 patients who were admitted to Shahid Mohammadi Hospital, Bandar Abbas, Iran, were examined. On the basis of the severity, the patients were grouped into two groups of moderate and severe patients. Patients in each group were then sub-categorized into high dose and low dose, according to the received dose of corticosteroids. Then we investigated the effect of different doses of corticosteroids on the course of recovery of Covid-19 cases.
Results: In the severe group, the patients who received high-dose of corticosteroids had a higher mortality rate as compared to the low-dose group. In both the severe and moderate groups, the LDH level of the patients who received low doses of corticosteroids at the time of discharge were significantly less compared to those who received high doses. In the moderate group, the percentage of lymphocytes in the low-dose corticosteroid group was considerably higher compared to the high-dose corticosteroid group at the time of discharge.
Conclusion: According to the results, in the case of patients with moderate clinical severity, a low dose of corticosteroids improved the disease, but in the case of patients with severe clinical severity, the results were contradictory, which may be caused by interference of other factors such as underlying diseases, the severity of the illness, etc. in the severe group.

Keywords: Corticosteroids, Covid-19, Mortality

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Type of Study: orginal article | Subject: General

References

1. De Vita A, Ravenna SE, Covino M, Lanza O, Franceschi F, Crea F, et al. Electrocardiographic findings and clinical outcome in patients with COVID-19 or other acute infectious respiratory diseases. J Clin Med 2020;9(11):3647. Available from: http://dx.doi.org/10.3390/jcm9113647. [DOI:10.3390/jcm9113647] [PMID] []

2. Arabi M, Heidari Beigvand H, Samimagham H, Salimi N, Kazemi Jahromi M. Upper limb ischemia following COVID-19 infection: A case report. Jundishapur J Microbiol 2022;15(1):e122074. Available from: http://dx.doi.org/10.5812/jjm.122074. [DOI:10.5812/jjm.122074]

3. Samimagham HR, Hassani Azad M, Arabi M, Ghazizadeh S, Malektojjari A, Hojjatipour M, et al. The effect of remdesivir in patients with severe COVID-19, reporting case series. Shiraz E Med J 2021;23(4):e116995. Available from: http://dx.doi.org/10.5812/semj.116995. [DOI:10.5812/semj.116995]

4. Rahimi A, Samimagham HR, Azad MH, Hooshyar D, Arabi M, KazemiJahromi M. The efficacy of N-Acetylcysteine in severe COVID-19 patients: A structured summary of a study protocol for a randomised controlled trial. Trials 2021;22(1):271. Available from: http://dx.doi.org/10.1186/s13063-021-05242-4. [DOI:10.1186/s13063-021-05242-4] [PMID] []

5. Hasani Azad M, Khorrami F, Kazemi Jahromi M, Alishan Karami N, Shahi M, Davari Dolatabadi N, et al. Clinical and epidemiological characteristics of hospitalized COVID-19 patients in Hormozgan, Iran: A retrospective, multicenter study. Arch Iran Med 2021;24(5):434-44. Available from: http://dx.doi.org/10.34172/aim.2021.62. [DOI:10.34172/aim.2021.62] [PMID]

6. Samimagham HR, Hassani Azad M, Hooshyar D, Arabi M, Reza Hosseini Z, Kazemi Jahromi M. Adverse effects of Gam-COVID-vac (sputnik V) vaccine. Shiraz E Med J 2021;22(12):e116278. Available from: http://dx.doi.org/10.5812/semj.116278. [DOI:10.5812/semj.116278]

7. Samimagham HR, Arabi M, Hooshyar D, KazemiJahromi M. The association of non-steroidal anti-inflammatory drugs with COVID-19 severity and mortality. Arch Clin Infect Dis 2020;15(4):e106847. Available from: http://dx.doi.org/10.5812/archcid.106847. [DOI:10.5812/archcid.106847]

8. Rahimi A, Samimagham HR, Azad MH, Hooshyar D, Arabi M, KazemiJahromi M. The efficacy of N-Acetylcysteine in severe COVID-19 patients: A structured summary of a study protocol for a randomised controlled trial. Trials 2021;22(1):271. Available from: http://dx.doi.org/10.1186/s13063-021-05242-4. [DOI:10.1186/s13063-021-05242-4] [PMID] []

9. Moey MYY, Sengodan PM, Shah N, McCallen JD, Eboh O, Nekkanti R, et al. Electrocardiographic changes and arrhythmias in hospitalized patients with COVID-19. Circ Arrhythm Electrophysiol 2020;13(10):e009023. Available from: http://dx.doi.org/10.1161/CIRCEP.120.009023. [DOI:10.1161/CIRCEP.120.009023] [PMID] []

10. Samimagham HR, Jahromi MK, Jahromi LK. COVID-19 with Pneumomediastinum and Emphysema, A Case Report. Shiraz E-Med J 2020;21(12):e109424. [DOI:10.5812/semj.109424]

11. Samimagham HR, Seddighi K, Daryanavard A, Kazemi Jahromi M. Recurrence of COVID-19 Infection. Shiraz E Med J 2020;22(8):e110656. Available from: http://dx.doi.org/10.5812/semj.110656. [DOI:10.5812/semj.110656]

12. Bertini M, Ferrari R, Guardigli G, Malagù M, Vitali F, Zucchetti O, et al. Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement. Europace 2020;22(12):1848-54. Available from: http://dx.doi.org/10.1093/europace/euaa258. [DOI:10.1093/europace/euaa258] [PMID] []

13. Ahmadi I, Estabraghnia Babaki H, Maleki M, Jarineshin H, Kaffashian MR, Hassaniazad M, et al. Changes in physiological levels of cortisol and adrenocorticotropic hormone upon hospitalization can predict SARS-CoV-2 mortality: A cohort study. Int J Endocrinol 2022;2022:4280691. Available from: http://dx.doi.org/10.1155/2022/4280691. [DOI:10.1155/2022/4280691] [PMID] []

14. Cortisone injection [Internet]. MedicineNet. [cited 2022 Sep 3]. Available from: https://www.medicinenet.com/cortisone_injection/article.htm. [URL]

15. Kapugi, M. and K. Cunningham, Corticosteroids. Orthop Nurs 2019;38(5):336-9. [DOI:10.1097/NOR.0000000000000595] [PMID]

16. Guarnotta V, Ferrigno R, Martino M, Barbot M, Isidori AM, Scaroni C, et al. Glucocorticoid excess and COVID-19 disease. Rev Endocr Metab Disord 2021;22(4):703-14. Available from: http://dx.doi.org/10.1007/s11154-020-09598-x. [DOI:10.1007/s11154-020-09598-x] [PMID] []

17. Dhasmana DJ. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021;384(8):693-704. Available from: http://dx.doi.org/10.1056/NEJMoa2021436. [DOI:10.1056/NEJMoa2021436] [PMID] []

18. Munck A, Guyre PM, Holbrook NJ. Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocr Rev 1984 Winter;5(1):25-44. Available from: http://dx.doi.org/10.1210/edrv-5-1-25. [DOI:10.1210/edrv-5-1-25] [PMID]

19. Zhou Y, Fu B, Zheng X, Wang D, Zhao C, Qi Y, et al. Pathogenic T-cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients. Natl Sci Rev 2020;7(6):998-1002. Available from: http://dx.doi.org/10.1093/nsr/nwaa041. [DOI:10.1093/nsr/nwaa041] [PMID] []

20. Qi J, He D, Yang D, Wang M, Ma W, Cui H, et al. Severity-associated markers and assessment model for predicting the severity of COVID-19: a retrospective study in Hangzhou, China. BMC Infect Dis 2021;21(1):774. Available from: http://dx.doi.org/10.1186/s12879-021-06509-6. [DOI:10.1186/s12879-021-06509-6] [PMID] []

21. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8(4):420-2. Available from: http://dx.doi.org/10.1016/S2213-2600(20)30076-X. [DOI:10.1016/S2213-2600(20)30076-X] [PMID]

22. Quispe-Laime AM, Bracco JD, Barberio PA, Campagne CG, Rolfo VE, Umberger R, et al. H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment. Intensive Care Med 2010;36(1):33-41. Available from: http://dx.doi.org/10.1007/s00134-009-1727-6. [DOI:10.1007/s00134-009-1727-6] [PMID] []

23. Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX randomized clinical trial: The CoDEX randomized clinical trial. JAMA 2020;324(13):1307-16. Available from: http://dx.doi.org/10.1001/jama.2020.17021. [DOI:10.1001/jama.2020.17021] [PMID] []

24. Lu H. Drug treatment options for the 2019-new coronavirus (2019-nCoV). Biosci Trends 2020;14(1):69-71. [DOI:10.5582/bst.2020.01020] [PMID]

25. Arabi YM, Mandourah Y, Al-Hameed F, Sindi AA, Almekhlafi GA, Hussein MA, et al. Corticosteroid therapy for critically ill patients with Middle East Respiratory Syndrome. Am J Respir Crit Care Med 2018;197(6):757-67. Available from: http://dx.doi.org/10.1164/rccm.201706-1172OC. [DOI:10.1164/rccm.201706-1172OC] [PMID]

26. Nasiri S, Vafai-manesh J, Adeli SH, Bagherzade M, Tabraii R. Investigating the effect of dexamethasone in patients with corona and hypoxia. Iran J Anesthesiol Spec Care 02021;2(113):20-8. [URL]

27. Corticosteroids for COVID-19.Who.int. World Health Organization; 2020 [cited 2022 Sep 3]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1. [URL]

28. Tlayjeh H, Mhish OH, Enani MA, Alruwaili A, Tleyjeh R, Thalib L, et al. Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis. J Infect Public Health 2020;13(11):1652-63. Available from: http://dx.doi.org/10.1016/j.jiph.2020.09.008. [DOI:10.1016/j.jiph.2020.09.008] [PMID] []

29. Lee KY, Rhim JW, Kang JH. Early preemptive immunomodulators (corticosteroids) for severe pneumonia patients infected with SARS-CoV-2. Clin Exp Pediatr 2020;63(4):117-8. Available from: http://dx.doi.org/10.3345/cep.2020.00290. [DOI:10.3345/cep.2020.00290] [PMID] []

30. Yang Z, Liu J, Zhou Y, Zhao X, Zhao Q, Liu J. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. J Infect 2020;81(1):e13-20. Available from: http://dx.doi.org/10.1016/j.jinf.2020.03.062. [DOI:10.1016/j.jinf.2020.03.062] [PMID] []

31. Angus DC, Derde L, Al-Beidh F, Annane D, Arabi Y, Beane A, et al. Effect of hydrocortisone on mortality and organ support in patients with severe COVID-19: The REMAP-CAP COVID-19 corticosteroid domain randomized clinical trial: The REMAP-CAP COVID-19 corticosteroid domain randomized clinical trial. JAMA 2020;324(13):1317-29. Available from: http://dx.doi.org/10.1001/jama.2020.17022. [DOI:10.1001/jama.2020.17022] [PMID] []