Clinical characteristics and corticosteroids application of different clinical types in patients with corona virus disease 2019

Abstract

To describe the epidemiological and clinical characteristics of patients with Corona Virus Disease 2019 (COVID-19) in Beijing. To analyze the application of corticosteroids in patients with severe pneumonia. We collected information on demographic characteristics, exposure history, clinical characteristics, corticosteroids use, and outcomes of the 65 confirmed cases of COVID-19 at Fifth Medical Center of PLA General Hospital from Jan 20 to Feb 23, 2020. The final follow-up date observed was April 15th, 2020. 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 (≤ 2 mg/kg day) and higher dose (> 2 mg/kg day) 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. Lymphocyte, especially T lymphocyte, in severe and critical patients showed a dramatic decrease. Application of lower dose corticosteroids (≤ 2 mg/kg day) 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.

Figure 1

Dynamic IL-6 levels and T lymphocyte counts trends of patients with COVID-19 in different group throughout the course of the COVID-19. (a,b) showed the T lymphocyte and IL-6 level trends in different clinical types throughout the course of the disease. T lymphocytes increased gradually as patients recovered. During treatment, the IL-6 levels fluctuated and then decreased to normal as patients recovered. There was no records of dynamic T lymphocytes and IL-6 levels in patients with mild type. (c,d) showed the IL-6 levels and T lymphocyte trends, respectively. The IL-6 levels in patients using corticosteroids decreased quickly after using corticosteroids. Whereas in patients without corticosteroids use, the decrease of IL-6 levels was later and more gradual as patients recovered. The T lymphocyte count trends had a similar pattern throughout the course of disease in patients with and without corticosteroids use. COVID-19, Corona Virus Disease 2019, IL-6 interleukin-6, mPSL methylprednisolone.