The Role of Methylprednisolone on Preventing Disease Progression for Hospitalized Patients with Severe COVID-19.

BACKGROUND COVID-19 is a public health emergency that is spreading worldwide and seriously affecting the global economy. Date on the effectiveness and safety of the use of methylprednisolone for patients with severe COVID-19 remains limited. METHODS In this retrospective study, epidemiological, clinical, laboratory, treatment and outcomes data of hospitalized patients with severe COVID-19 in Zhongnan Hospital of Wuhan University from January 1 to March 7, 2020, were collected. Binary logistic regression model was use to analyse risk factors for disease progression from severe COVID-19 illness to critical illness. The effectiveness and safety of the use of methylprednisolone for patients with severe COVID-19 disease were evaluated. RESULTS The results of the multivariate analysis from 175 patients with severe COVID-19 indicate that the use of methylprednisolone was a protective factor against disease progression from severe to critical illness(P<0.001; OR: 0.054 95% CI: 0.017-0.173). Among patients with severe COVID-19 aged<65 years, both the proportion of patients who progressed to critical illness (42.2% vs 90.0%, P=0.000) and the mortality(6.7% vs 30.0%, P=0.002) were lower for patients in methylprednisolone group, compared with those in the non-methylprednisolone group, whereas no statistical differences between the methylprednisolone group and the non-methylprednisolone group were found among COVID-19 patients older than 65 years. Moreover, both the levels of CD4+ T lymphocyte counts (646 vs 463/ul, P=0.007) and IL-6(241.9 vs 82.8pg/ml, P=0.025) were higher among patients with severe COVID-19 aged<65 years, compared with those patients ≥65 years old. CONCLUSION Data from the limited sample showed that the early use of low or medium doses of methylprednisolone have a positive effect for patients with severe COVID-19 younger than 65 years old, and excessive immune response and cytokine storm may be some of the reasons for the effectiveness.