A blood test can tell which COVID-19 patient should get steroid treatment and who would react adversely to it
The study suggested steroid therapy may benefit patients with severe inflammation, but may negatively impact those with less severe inflammation
COVID-19 has affected more than 15 million people in the world so far. Out of these, over nine million have recovered and about 636,479 have succumbed to the disease.
Increased inflammation in patients is considered to be one of the causes of mortality in patients. Recently, the RECOVERY trials in the UK suggested that dexamethasone (a steroid drug) can reduce deaths by one-third in patients on ventilators and one-fifth in those on oxygen therapy.
Now, a group of researchers at the Albert Einstein College of Medicine say that the levels of CRP (C-reactive protein) may have something to do with the effects of steroids like dexamethasone on a person and a single blood test can tell which patients would benefit from steroid therapy and which ones won’t.
The findings of their study are published in the peer-reviewed medical journal, Journal of Hospital Medicine.
Glucocorticoids are a class of corticosteroid drugs that have a structure and function similar to that of the stress hormone cortisol in our body. These drugs reduce inflammation, suppress the immune system and help constrict blood vessels and are used to treat inflammatory and autoimmune diseases.
Glucocorticoids mediate their function in two different ways - genomic and non-genomic. In the genomic pathway, glucocorticoids suppress the production of many pro-inflammatory molecules and increase the production of anti-inflammatory substances. These actions take a few hours to days to occur. However, the non-genomic actions show their effects within seconds of use. For the latter, the glucocorticoids interact with various cell surface receptors to control inflammation.
For the study, the scientists assessed 1,806 COVID-19 patients from the four hospitals of Montefiore Medical Center in Bronx, New York between 11 March and 13 April, 2020. Out of these patients, 140 were treated with glucocorticoids within the first two days of admission and the rest 1,666 did not receive glucocorticoids. Most patients who got steroid therapy had been given prednisone; however, some were given dexamethasone and methylprednisolone.
All the patients had their CRP levels checked at the beginning of the study. CRP or C-reactive protein is a compound that our liver produces in response to inflammation in the body. As per the study, CRP levels below 8 mg per deciliter mg/dL of blood are normal.
Here are the findings of the study:
- About 75 percent reduction in the risk of death was noted in those with excessive inflammation and a CRP level greater than 20mg/dL.
- Those with low inflammation and CRP levels less than 10 had a 200% higher risk of death or need for mechanical ventilation when put on steroid therapy.
The study suggested that while steroid therapy may be beneficial for COVID-19 patients with severe inflammation, it may have negative effects on those with less inflammation.
“Our findings suggest that steroid therapy should be reserved for people with high inflammation, as indicated by markedly elevated CRP levels,” Dr William Southern, senior author of the study and Chief, Department of Medicine Division of Hospital Medicine at the Albert Einstein College of Medicine and Montefiore Medical Center, stated in a news release.
Explaining the importance of their findings, Dr Marla Keller, the lead author of the study said, “Our study is consistent with the promising findings from Britain, but for the first time, we are able to demonstrate that people can see the same life-saving benefits with steroid formulations other than dexamethasone.”
For more information, read our article on COVID-19 and inflammation.
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