Clinical Characteristics and Corticosteroids Application of Different Clinical Types in Patients with Corona Virus Disease 2019
Fangfang Liu, Chengcheng Ji, Jiajun Luo, Weiwei Wu, Junchang Zhang, Zhiqiang Zhong, Seth Lankford, Huang Huang, Fang Lin, Yonggang Wang, Guoxin Mo, Xingshuo Hu, Tianjun Jiang, Yanling Shao, Sumin Ji, Yawei Zhang, Enqiang Qin, Jinsong Mu
Received date: 19th March 2020
Objective: To describe the epidemiological and clinical characteristics of patients with Corona Virus Disease 2019 (COVID19) in Beijing. To analyze the application of corticosteroids in patients with severe pneumonia.
Methods: We collected information on demographic characteristics, exposure history, clinical characteristics, corticosteroids use, and outcomes of the 65 confirmed cases of COVID19 at the 5th Medical Center of PLA General Hospital from Jan 20 to Feb 23, 2020. The final follow-up date observed was April 15th, 2020.
Results: The number of patients with mild, general, severe, and critical type were 10 (15.38%), 32 (49.23%), 8 (12.31%), and 15 (23.08%), respectively. The median incubation period was 6 days. Notable outliers were 1 patient at 16 days and 1 patient at 21 days. In lymphocyte subgroup analysis, decreases in total, T, CD4, and CD8 lymphocytes were more common as the disease worsened (All P<0.05). Methylprednisolone (mPSL) was applied to 31 (47.69%) patients with pneumonia, including 10 (31.25%) general, 8 (100%) severe, and 13 (86.67%) critical patients, respectively. Corticosteroids inhibited Interleukin-6(IL-6) production (P=0.0215) but did not affect T lymphocyte (P=0.0796). There was no significant difference between patients using lower dose (≤2mg/kg.d) and higher dose (>2mg/kg.d) mPSL in inhibiting IL-6 production (P=0.5856). Thirty of 31 patients (96.77%) had stopped mPSL due to improvement of pneumonia. Virus RNA clearance time lengthened with disease progression (P=0.0001). In general type, there was no significant difference in virus clearance time between patients with (15, 12-19 days) and without (14.5, 11-18 days) (P=0.7372) mPSL use.
Conclusions: Lymphocyte, especially T lymphocyte, in severe and critical patients showed a dramatic decrease. Application of lower dose corticosteroids (≤2mg/kg.d) could inhibit IL-6 production (a representative of cytokines) as effectively as a higher dose. Proper use corticosteroids in general type patients did not delay virus clearance.
This is an abstract of a preprint hosted on a preprint server, which is currently undergoing peer review at Scientific Reports. The findings have yet to be thoroughly evaluated, nor has a decision on ultimate publication been made. Therefore, the results reported should not be considered conclusive, and these findings should not be used to inform clinical practice, or public health policy, or be promoted as verified information.