Precautions of corticosteroids treatment in patients with 2019-nCoV
There is no fixed clinical guideline for the use of corticosteroids in critically ill patients in ICU. The anecdotal experience from SARS and sCAP therapy strongly supports precise corticosteroids management of NCP. Personalized medicine strategy should contain, but not limited to, specific indications, timing and duration, as well as therapeutic monitoring of corticosteroids therapy. As mentioned above, corticosteroids should be avoided unless there are indications for moderate or severe ARDS, sepsis or septic shock, in part consistent with the recommended clinical guidance from World Health Organization (WHO). We also do not suggest the use of corticosteroids for mild or early-stage ARDS, because early corticosteroids application could delay the clearance of virus and increase mortality risk, and corticosteroids are more likely to function on inflammation-mediated lung injury and interstitial fibro-proliferation at late-stage of ARDS11. Furthermore, clinical adverse complications in SARS patients with corticosteroids treatment have been reported to be dose-related. Over 240 mg of hydrocortisone-equivalent dose or an excessive cumulative dose was considered to be able to generate some side effects, including hyperglycemia, psychosis, and secondary infection, avascular necrosis9,10. Hence, lower dose and short duration of corticosteroids treatment (methylprednisolone, <1 mg/kg body weight, no more than 7 days), along with adverse drug reaction monitoring, would be more beneficial in clinical management of critical patients with 2019-nCoV. In addition, a long-term follow-up (6 months to 3 years) is essential to identify delayed adverse effects in these patients. Of course, the optimal treatment strategy requires constant adjustment as patient’s clinical performance changes.
In conclusion, Chinese government has taken effective measures to prevent a possible national or worldwide 2019-nCoV pandemic. Offering the most reasonable treatment to severe NCP patients could be another challenge we will face. We endorse the potential benefits from low-dose corticosteroids treatment in a subset of critically ill patients with 2019-nCoV based on existing studies and clinical experience, despite there is no significant improvement in overall survival. Certainly, our ongoing well-designed prospective cohort study with sufficient samples may provide systematic answers to this clinical dilemma—“to use or not to use corticosteroids for the treatment of lung injury with 2019-nCoV”—in the near future.