Efremov Dmitry3-rd A. A. Vishnevsky Central Military Hospital, Russian Federation
Title: Risk factors associated with corticosteroid failure in hospitalized patients with moderate COVID-19
Relevance: Clinical and laboratory markers to predict the effectiveness of the treatment of coronavirus infection are important. To date, there is evidence showing that age, comorbidity, and a number of laboratory parameters in patients with COVID-19 are associated with the severity of the disease and the risk of adverse outcomes. However, data on markers to predict the effectiveness of response to anti-inflammatory therapy in patients with moderate COVID-19 are insufficient.
Objective: To identify predictors of low efficacy of short-course glucocorticosteroid (GCS) monotherapy in patients with moderate COVID-19.
Materials and methods: A retrospective analysis of the data of electronic medical records of all patients admitted sequentially from October 1, 2020 to January 31, 2021 was carried out. The study included 71 patients with a probable (clinically confirmed) and confirmed (laboratory) case of COVID-19 of moderate course, with characteristic changes in the lungs according to computed tomography of the chest organs. Considering the severity of the course, all patients of this sample were prescribed corticosteroids according to the scheme.
Results:The average age of patients included in the study was 57.4±11.8 (54.6-60.2) years, males predominated - 71.8%. Patients were admitted to the hospital on an average of 7.1±3.0 (6.4-7.8) days of illness. Corticosteroids were prescribed on average on the 7.9±3.0 (7.2-8.6) day of illness. Of this sample (n=71), 74.7% of patients did not require an escalation of anti-inflammatory therapy, which can be considered an effective prescription of corticosteroids as monotherapy (group 1). Patients (n = 18), who, on average, on day 5 (day 3-6) from the start of the use of GCS, monotherapy had no effect, additionally used monoclonal antibodies (MA) to interleukin-6 (IL-6) or to its receptor (group 2). When comparing the groups, significant differences (P<0.05) were revealed in terms of: the absolute number of lymphocytes (1.4 (0.9-1.9) vs 1.0 (0.7-1.3) x 109/ l) and platelets (172 (127-215) vs 138.5 (120-160) x 1012/l) in the clinical analysis of blood, body temperature (37.9 (37.5-38.5) vs 38.5 (38.5-39.0) Co). The presence of absolute lymphopenia, thrombocytopenia and febrile fever moderately correlated with a low response to the use of corticosteroids. Statistical hypotheses were formulated: (1) in patients with a normal number of lymphocytes, compared with patients with lymphopenia, the probability of successful use of GCS is higher, (2) in patients with a normal number of platelets, compared with patients with thrombocytopenia, the probability of successful use of GCS is higher, (3) patients with subfebrile body temperature, compared with patients with febrile body temperature, the likelihood of successful use of corticosteroids is higher. To determine the quantitative assessment of the relationship between the risk factor and the outcome, the odds ratio (OR) and 95% confidence interval (CI) were calculated. For hypothesis 1: OR 0.219, 95% CI (0.064-0.755), P<0.05; for hypothesis 2: OR 0.355, 95% CI (0.116-1.090), P<0.05; for hypothesis 3: OR 0.103, 95% CI (0.022-0.495), P<0.05. Thus, the data obtained show that (1) patients with lymphopenia have a 4.56 times higher chance of failure of GCS therapy than patients with a normal lymphocyte count; (2)
in patients with thrombocytopenia, the chance of failure of GCS therapy is 3.66 times higher than in patients with a normal platelet count; (3) in patients with febrile fever, the chance of failure of GCS therapy is 9.71 times higher than in patients with subfebrile fever.
Efremov Dmitry - infectious diseases doctor. Works at Branch No. 1 of the 3rd A. A. Vishnevsky Central Military Hospital of the Ministry of the Defense of the Russian Federation, Russia, Krasnogorsk. Range of national interests: infectious diseases, chronic viral hepatitis, COVID-19. Has several publications, is working on a dissertation for the degree of candidate of medical sciences