Salvage corticosteroids treatment for critical patients with 2019-nCoV?
Corticosteroids are widely used to prevent lung injury caused by severe community-acquired pneumonia (sCAP) due to their excellent pharmacological effects on the suppression of exuberant and dysfunctional systematic inflammation5. Some scholars may not support the corticosteroids treatment for novel coronavirus pneumonia (NCP), because observational studies and systematic reviews have indicated inconclusive clinical evidence on the effect of corticosteroids therapy for viral pneumonias (such as SARS, MERS and H1N1). Additionally, pulse-dose therapy or long-term administration to high dose of corticosteroids in early stage were reported to be possibly harmful6–8. However, these conclusions obscured the clinical benefits of corticosteroids on some subgroups of patients, particularly those with severe symptoms, as the clinical effects might be related to the indication (severities of illness), the timing of intervention, the dose and duration of corticosteroids therapy9.
Of note, as documented in a series of randomized clinical trials (RCT), low or physiologic dose of corticosteroids treatment did not reduce mortality from septic shock caused by primary lung infections, but it could bring clinical benefits to secondary outcomes, such as earlier reversal of shock, shorter duration to exit from ICU and mechanical ventilation9,10. Besides, salvage corticosteroids treatment for severe patients with advanced ARDS could alleviate the pulmonary fibrosis and prevent progressive pathological deterioration11, which provides a good framework for explaining why some critical patients with SARS infection benefit from rescue corticosteroids therapy. More importantly, mortality benefit favored the severe HIN1-illness in the adjunctive treatment group with low dose of corticosteroids12. Evidently, all these results strongly suggest that proper use of low-dose corticosteroids may bring survival advantages for critically ill patients with 2019-nCoV, but this treatment should be strictly performed on NCP patients with definite clinical indications (such as refractory ARDS, sepsis or septic shock) according to the recommended guidelines.