In December 2019, SARS-COV-2 was isolated from patients for the first time . It thenrapidly turned into a pandemic affecting the whole world.While most Covid patientssurvive the disease with mild symptoms, some may develop severe organ failure andrespiratory failure requiring mechanical ventilation. COVİD-19 pneumonia may progressinto acute respiratory distress syndrome (ARDS). The most important reason for this hasbeen shown in studies; is thought to be because a group of patients develop a cytokinestorm-associated hyperinflammatory state characterized by features of macrophageactivation syndrome (MAS). The aim of this study was to evaluate the clinical outcomes ofthe combined use of pulse steroid and intravenous immunoglobulin therapy in patients withsevere COVID-19 with severe respiratory distress in intensive care unit.
In December 2019, SARS-COV-2 was isolated from patients for the first time . It then
rapidly turned into a pandemic affecting the whole world.While most Covid patients
survive the disease with mild symptoms, some may develop severe organ failure and
respiratory failure requiring mechanical ventilation . COVİD-19 pneumonia may progress
into acute respiratory distress syndrome (ARDS) , diffuse alveolar damage, and vascular
endothelitis, which is comlicated with trombosis and hemorrhage. .
The most important reason for this has been shown in studies; is thought to be because a
group of patients develop a cytokine storm-associated hyperinflammatory state
characterized by features of macrophage activation syndrome (MAS), such as lymphopenia,
elevated ferritin and elevated d-dimer. Increased proinflammatory cytokine release,
especially as a result of stimulation of the immune system, has been shown to be
associated with this hyperinflammatory phase .
The immune system triggered by viral infections is essential for fighting pathogens.
However, the excessive production of pro-inflammatory cytokines caused by SARS-COV-2 can
cause tissue damage that can lead to fatal acute respiratory distress .
Therefore, aiming to suppress the cytokine storm seems to be of critical importance for
COVID-19 and similar respiratory infections that cause acute respiratory distress . Many
agents have been used for this purpose, but there is no clear evidence for the management
and treatment of cytokine storm.
Immunosuppression plays an important role in the treatment of cytokine storm. Studies
have reported positive results of steroids used for this purpose in elderly COVID-19
patients . Various immunomodulatory agents have also been used for this purpose. In
addition to treatments targeting a specific molecule such as IL-6, IL-1, agents that
affect various branches of the immune inflammatory system such as intravenous
immunoglobulin can be used .
The aim of this study was to evaluate the clinical outcomes of the combined use of pulse
steroid and intravenous immunoglobulin therapy in patients with severe COVID-19 with
severe respiratory distress in intensive care unit.
Drug: pulse steroid and nanogam
patients received pulse steroid and ivig treatments in addition to standard treatment.
Inclusion Criteria:
- Adult patients with 2019-ncov infection confirmed by PCR;
- Absolute value of lymphocytes < 0. 6x 109/L;
- Brescia-COVID respiratory severity scale (BCRSS) score ≥3
- Hyperinflammation (defined as elevation of C-reactive protein (CRP) ≥50 mg/L or
ferritin ≥500 ng/ ml)
- Severe respiratory failure within 48 hours and requires admission to ICU. (severe
respiratory failure was defined as PaO2/FiO2 < 300 mmHg and was supported by
positive pressure mechanical ventilation (including non-invasive and invasive
mechanical ventilation, PEEP>=5cmH2O))
Exclusion Criteria:
- Age < 18
- Pregnant
- Allergic to experimental drugs
- The underlying disease is very serious and the expected survival time is less than 6
months (such as advanced malignant tumor);
- COPD or end-stage lung disease requires home oxygen therapy
- Expected survival time not exceeding 48 hours
- Autoimmune diseases
Konya City Hospital
Konya 306571, Turkey (Türkiye)
Not Provided