At most of patients of COVID-19 proceeds benign, but at elderly people and persons with associated diseases the serious illness demanding hospitalization and an intensive care can develop. The pathophysiology of a disease is provided in two distinctly crossed phases: initial pathogenic virus reaction which inflammatory reaction of varying severity and various clinical results follows. Pathological progressing at a severe form of COVID-19 includes the excess and unregulated pro-inflammatory tsitokinovy storm leading to immunopathological injury of lungs, diffusion damage of alveoluses with development acute respiratory a distress syndrome (ORZ) and to a lethal outcome.
For lack of any checked anti-virus therapy, mainly, the maintenance therapy, additional oxygen and artificial ventilation of the lungs is applied now. The assessment of adjyunktivny therapy is carried out by the immunomodulators allocated for an inflammatory tsitokinovy storm. Therapy researches corticosteroids for phylogenetic similar koronavirusny infections did not show either advantage, or potential harm. Despite frequent use in China for patients with COVID-19, the role of corticosteroids is not defined. In later observation research it was reported about improvement of results at patients with COVID - the associated ORZ, receiving corticosteroids.
The research which authors assumed that early treatment by a short course of corticosteroids of patients with COVID-19 can weaken excessive respiratory and system inflammatory reactions of an organism was conducted.
The essence of a research was that it joined the patients who are consistently hospitalized during the period from March 12 to March 27, 2020 if they were more senior than 18 years, had the confirmed COVID-19 infection with radiological signs of bilateral pulmonary infiltrates and needed oxygen through a nasal cannula, a high-line nasal cannula (HFNO) or mechanical ventilation of the lungs. The research did not join the patients who died within 24 hours after receipt in emergency department or hospitalized less than for 24 hours.
Patients with COVID-19 were stratified on a risk degree depending on weight of symptoms at receipt in hospital as easy, moderate or heavy. Patients without hypoxia or short wind at an exercise stress were considered having light severity. Patients with easy COVID-19 form received only a symptomatic treatment and did not come to hospital. The patients who had infiltrates on the roentgenogram of a thorax and needing additional oxygen through a nasal cannula or a high-line nasal cannula (HFNO) were classified as having moderate COVID-19. Patients with the respiratory insufficiency demanding artificial ventilation of the lungs were classified as having heavy COVID-19.
Patients were divided into group of standard treatment and group of early use of corticosteroids. Patients of both studied groups received the standard medical care including additional oxygen through a high-line nasal cannula, invasive ventilation of the lungs, antibiotics, antiviral drugs, angiotonic support and replacement renal therapy as it was defined by the main group. Patients with a moderate or serious illness originally received a maintenance therapy with use or without combination of a lopinavira-ritonavir and a ribavirin or hydroxychloroquine according to the institutional management developed by infectiologists and druggists.
In group of early use of corticosteroids moderate COVID-19 treated hydroxychloroquine on 400 mg twice a day during 2 doses for the 1st day, and then on 200 mg twice a day for the 2-5th day. With moderate COVID-19 by which 4 l and more oxygen in a minute were required at receipt or at which increase of oxygen requirement was observed it was recommended to patients to enter intravenously Methylprednisolonum of 0.5-1 mg/kg into days in 2 separate doses within 3 days. It was recommended to the patients needing hospitalization in ORIT to receive the above-stated mode of intake of hydroxychloroquine and intravenous Methylprednisolonum of 0.5-1 mg/kg in days in 2 divided doses within 3–7 days.
Data were collected from the electronic medical record of each establishment and introduced in the standardized electronic form of the report on each case. Demographic data, information on clinical symptoms or signs at receipt were considered and also laboratory and radiological results at receipt. All laboratory researches and X-ray inspections, including a usual X-ray analysis of a thorax and a computer tomography of a thorax, were conducted at the discretion of the attending physician.
In the analysis of results of a research it was established that the early short course of use of Methylprednisolonum for patients with moderate and heavy degree of COVID-19 reduced escalation of treatment and improved clinical results.