PMC:7035340 / 4002-7503
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7035340","sourcedb":"PMC","sourceid":"7035340","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7035340","text":"Current evidence: clinical benefits of corticosteroids therapy for critical NCP patients\nOver the past month, we collaborated with front-line ICU physicians and firstly evaluated the efficacy of corticosteroids treatment for severe or fatal cases with 2019-nCoV infection in Wuhan. From January 1 to January 29, 2020, the first 15 confirmed critical NCP patients with an average age of 61.7 years were admitted to the ICU in Wuhan Pulmonary Hospital. Of the 15 patients, 15 (100.0%) showed bilateral pneumonia, hypoxemia and moderate or severe ARDS, 14 (93.3%) had infections, 8 (53.3%) accompanied by shock and 9 (60.0%) with multiple organ injuries. All patients had received treatments containing noninvasive oxygen therapy and antibiotics and/or antiviral agents before and after ICU admission, and hypoxemia was not improved by these treatments. According to the guidelines, corticosteroids therapy (median hydrocortisone-equivalent dose of 400.0 mg/day) was instantly initiated after ICU admission for an average of 9.5 days, and outcomes for all patients were followed up until February 9, 2020 (Fig. 1a and Fig. S1c). Briefly, we observed that ICU mortality of these severe or fatal NCP patients was 46.7% (7/15), closer to that after adjustment for time-varying confounders induced by critically ill patients with MERS without corticosteroids treatment6, suggesting that corticosteroids might not improve ICU mortality in critical NCP patients. But meanwhile, systematic corticosteroids therapy in the first 3−5 days could enhance oxygen saturation (SaO2) and arterial oxygen tension (PaO2)/inspiratory oxygen fraction (FiO2), both of which could be further augmented by collaborating with invasive mechanical ventilation (IMV) (Fig. 1b). Corticosteroids did not exert any intervention efficacy on survival advantage of NCP patients complicated with both ARDS and shock or multiple organ injury (seven patients, all dead). Nevertheless, corticosteroids treatment in the phase of ARDS would effectively inhibit furious inflammatory storm (Fig. 1b) and gain valuable time for controlling infection and preventing secondary multiorgan damage and shock, which implies that corticosteroids have synergistic biological effects when combined with other intensivists’ treatment against severe or fatal NCP patients.\nFig. 1 Corticosteroids treatment for severely ill patients with 2019-nCoV. a Demographics and baseline characteristics of patients infected with 2019-nCoV according to survival condition. aOf the 14 infections, 12 with identified pathogens, 2 diagnosed by characteristic clinical symptoms without identified pathogens; bN = 7. *P \u003c 0.05, a significant difference between the two groups. b Part of indexes of 15 critically ill patients with 2019-nCoV infection during corticosteroids therapy. *P \u003c 0.05 vs. the indexes on day 1. SaO2 oxygen saturation, CS corticosteroids, IMV invasive mechanical ventilation, PaO2/FiO2 ratio of arterial oxygen tension to fractional inspired oxygen concentrations, WBC white blood cell, CRP C-reaction protein, FIB fibrinogen\nDue to the deficiency of sample size and a matched control group, we could not easily draw an accurate conclusion about the role of corticosteroids in patients with 2019-nCoV by now. However, our clinical experience and available descriptive data from the therapeutic process of the first 15 critical NCP patients are prone to support corticosteroids treatment for specific subgroup of critically ill patients with 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