Skip to main content
Top
Published in: Virology Journal 1/2023

Open Access 01-12-2023 | Glucocorticoid | Research

Relationship between glucocorticoids and viral load during the Omicron wave in mainland China

Authors: Guangxu Bai, Yan Li, Yang Liu, Xinming Wang, Xuezhong Yu, Lili Ren, Jun Xu

Published in: Virology Journal | Issue 1/2023

Login to get access

Abstract

Background

Coronavirus disease 19 (COVID-19) is a major public health problem that cannot be ignored. As a widely used drug in the treatment of COVID-19, whether glucocorticoids may accelerate the clearance of COVID-19 is still not clear, and the glucocorticoids may improve the prognosis of patients is also controversial. Therefore, to explore the relationship between COVID-19 viral load and the use of glucocorticoids we designed this study.

Methods

Patients with COVID-19 infection who were admitted to the emergency department of Peking Union Medical College Hospital from the end of 2022 to early 2023 were enrolled in this study. Characteristics of baseline, clinical and laboratory evaluation especially immunological indicator and daily viral load were carefully collected. Kolmogorov–Smirnov test, Student’s t test, Mann–Whitney U test and proportional-hazards model (Cox model) were chosen as appropriate for comparison of variables.

Results

By comparing the daily COVID-19 viral load and prognosis of patients with and without glucocorticoid therapy, we found that glucocorticoids did not statistically enhance the clearance or replication of COVID-19, nor did it change the 28-days and in-hospital mortality. However, glucocorticoid therapy may be a favorable factor for COVID-19 negative conversion in Cox model. The inflammatory factors in patients with glucocorticoid therapy were significantly decreased.

Conclusions

We believe that the real effect of glucocorticoids may be to improve the destruction of host immune system caused by inflammatory storm through host immune regulation and then achieve the improvement of clinical symptoms.
Literature
1.
go back to reference Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus Disease 2019 (COVID-19). JAMA. 2020;324(8):782.CrossRefPubMed Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus Disease 2019 (COVID-19). JAMA. 2020;324(8):782.CrossRefPubMed
2.
go back to reference Lawler PR, Derde L, van de Veerdonk FL, et al. Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on Organ Support-Free days in patients hospitalized with COVID-19: a Randomized Clinical Trial. JAMA. 2023;329(14):1183–96.CrossRefPubMedPubMedCentral Lawler PR, Derde L, van de Veerdonk FL, et al. Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on Organ Support-Free days in patients hospitalized with COVID-19: a Randomized Clinical Trial. JAMA. 2023;329(14):1183–96.CrossRefPubMedPubMedCentral
3.
go back to reference Bloch EM et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest 2020; (130): 2757–65. Bloch EM et al. Deployment of convalescent plasma for the prevention and treatment of COVID-19. J Clin Invest 2020; (130): 2757–65.
4.
go back to reference Abani O, Abbas A, Abbas F, et al. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial. Lancet. 2021;397(10289):2049–59.CrossRef Abani O, Abbas A, Abbas F, et al. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial. Lancet. 2021;397(10289):2049–59.CrossRef
5.
go back to reference Rafiullah M, Siddiqui K. Corticosteroid use in viral Pneumonia: experience so far and the dexamethasone breakthrough in coronavirus disease-2019. J Comp Effect Res. 2020;9(18):1247–54.CrossRef Rafiullah M, Siddiqui K. Corticosteroid use in viral Pneumonia: experience so far and the dexamethasone breakthrough in coronavirus disease-2019. J Comp Effect Res. 2020;9(18):1247–54.CrossRef
6.
go back to reference Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of dexamethasone on days alive and Ventilator-Free in patients with moderate or severe Acute Respiratory Distress Syndrome and COVID-19. JAMA. 2020;324(13):1307.CrossRefPubMed Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of dexamethasone on days alive and Ventilator-Free in patients with moderate or severe Acute Respiratory Distress Syndrome and COVID-19. JAMA. 2020;324(13):1307.CrossRefPubMed
7.
go back to reference Johnson RM, Vinetz JM. Dexamethasone in the management of covid – 19. BMJ 2020:m2648. Johnson RM, Vinetz JM. Dexamethasone in the management of covid – 19. BMJ 2020:m2648.
8.
go back to reference Horby P, Lim WS, Emberson JR, et al. Dexamethasone in hospitalized patients with Covid-19. RECOVERY collaborative group. N Engl J Med. 2021;384(8):693–704.CrossRefPubMed Horby P, Lim WS, Emberson JR, et al. Dexamethasone in hospitalized patients with Covid-19. RECOVERY collaborative group. N Engl J Med. 2021;384(8):693–704.CrossRefPubMed
9.
go back to reference Lamontagne F, Agarwal A, Rochwerg B et al. A living WHO guideline on drugs for covid-19. BMJ 2020:m3379 (updated on 13 Jan 2023). Lamontagne F, Agarwal A, Rochwerg B et al. A living WHO guideline on drugs for covid-19. BMJ 2020:m3379 (updated on 13 Jan 2023).
10.
go back to reference He Q, Song X, Huang Y, et al. Dexamethasone stimulates Hepatitis B Virus (HBV) replication through Autophagy. Med Sci Monitor. 2018;24:4617–24.CrossRef He Q, Song X, Huang Y, et al. Dexamethasone stimulates Hepatitis B Virus (HBV) replication through Autophagy. Med Sci Monitor. 2018;24:4617–24.CrossRef
11.
go back to reference Moreno G, Rodríguez A, Reyes LF, et al. Corticosteroid treatment in critically ill patients with severe Influenza Pneumonia: a propensity score matching study. Intens Care Med. 2018;44(9):1470–82.CrossRef Moreno G, Rodríguez A, Reyes LF, et al. Corticosteroid treatment in critically ill patients with severe Influenza Pneumonia: a propensity score matching study. Intens Care Med. 2018;44(9):1470–82.CrossRef
12.
go back to reference Arabi YM, Mandourah Y, Al-Hameed F, et al. Corticosteroid therapy for critically Ill patients with Middle East Respiratory Syndrome. Am J Resp Crit Care. 2018;197(6):757–67.CrossRef Arabi YM, Mandourah Y, Al-Hameed F, et al. Corticosteroid therapy for critically Ill patients with Middle East Respiratory Syndrome. Am J Resp Crit Care. 2018;197(6):757–67.CrossRef
13.
go back to reference Yang Z, Liu J, Zhou Y, Zhao X, et al. The effect of corticosteroid treatment on patients with coronavirus Infection: a systematic review and meta-analysis. J Infect. 2020;1(81):e13–20.CrossRef Yang Z, Liu J, Zhou Y, Zhao X, et al. The effect of corticosteroid treatment on patients with coronavirus Infection: a systematic review and meta-analysis. J Infect. 2020;1(81):e13–20.CrossRef
14.
go back to reference Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of Disease classification system. Crit Care Med. 1985;13:818–29.CrossRefPubMed Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of Disease classification system. Crit Care Med. 1985;13:818–29.CrossRefPubMed
15.
go back to reference Vincent JL, Moreno R, Takala J, on behalf of the Working Group on Sepsis related Problems of the European Society of Intensive Care Medicine, et al. The SOFA (Sepsis-related Organ failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22:707–10.CrossRefPubMed Vincent JL, Moreno R, Takala J, on behalf of the Working Group on Sepsis related Problems of the European Society of Intensive Care Medicine, et al. The SOFA (Sepsis-related Organ failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22:707–10.CrossRefPubMed
16.
go back to reference Cruz-Topete D, Cidlowski JA. One hormone, two Actions: Anti- and Pro-inflammatory effects of glucocorticoids. Neuroimmunomodulation. 2014;22(1–2):20–32.PubMed Cruz-Topete D, Cidlowski JA. One hormone, two Actions: Anti- and Pro-inflammatory effects of glucocorticoids. Neuroimmunomodulation. 2014;22(1–2):20–32.PubMed
17.
go back to reference Confalonieri M, Kodric M, Santagiuliana M, Longo C, Biolo M, Cifaldi R, Torregiani C, Jevnikar M. To use or not to use corticosteroids for Pneumonia? A clinician’s perspective. Monaldi Arch Chest Dis. 2012;77(2):94–101.PubMed Confalonieri M, Kodric M, Santagiuliana M, Longo C, Biolo M, Cifaldi R, Torregiani C, Jevnikar M. To use or not to use corticosteroids for Pneumonia? A clinician’s perspective. Monaldi Arch Chest Dis. 2012;77(2):94–101.PubMed
18.
go back to reference Wang GF, Li N, Wu YF, et al. The COX regression analysis on the use of corticosteroids in the treatment of SARS [in Chinese]. Zhonghua Yi Xue Za Zhi. 2004;84:1073–8.PubMed Wang GF, Li N, Wu YF, et al. The COX regression analysis on the use of corticosteroids in the treatment of SARS [in Chinese]. Zhonghua Yi Xue Za Zhi. 2004;84:1073–8.PubMed
19.
go back to reference Zhao Z, Zhang F, Xu M, et al. Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China. J Med Microbiol. 2003;52:715–20.CrossRefPubMed Zhao Z, Zhang F, Xu M, et al. Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China. J Med Microbiol. 2003;52:715–20.CrossRefPubMed
20.
go back to reference Auyeung TW, Lee JS, Lai WK, et al. The use of corticosteroid as treatment in SARS was associated with adverse outcomes: a retrospective cohort study. J Infect Dis. 2005;51:98–102. Auyeung TW, Lee JS, Lai WK, et al. The use of corticosteroid as treatment in SARS was associated with adverse outcomes: a retrospective cohort study. J Infect Dis. 2005;51:98–102.
21.
go back to reference Han K, Ma H, An X, et al. Early Use of glucocorticoids was a risk factor for critical Disease and death from pH1N1 Infection. Clin Infect Dis. 2011;53(4):326–33.CrossRefPubMed Han K, Ma H, An X, et al. Early Use of glucocorticoids was a risk factor for critical Disease and death from pH1N1 Infection. Clin Infect Dis. 2011;53(4):326–33.CrossRefPubMed
22.
go back to reference Jain S, Kamimoto L, Bramley AM, et al. Hospitalized patients with 2009 H1N1 inflfluenza in the United States, April–June 2009. N Engl J Med. 2009;361:1935–44.CrossRefPubMed Jain S, Kamimoto L, Bramley AM, et al. Hospitalized patients with 2009 H1N1 inflfluenza in the United States, April–June 2009. N Engl J Med. 2009;361:1935–44.CrossRefPubMed
23.
go back to reference Chien YS, Su CP, Tsai HT, et al. Predictors and outcomes of Respiratory Failure among hospitalized Pneumonia patients with 2009 H1N1 inflfluenza in Taiwan. J Infect Dis. 2010;60:168–74. Chien YS, Su CP, Tsai HT, et al. Predictors and outcomes of Respiratory Failure among hospitalized Pneumonia patients with 2009 H1N1 inflfluenza in Taiwan. J Infect Dis. 2010;60:168–74.
24.
go back to reference World Health Organization. WHO Guidelines for Pharmacological Management of Pandemic Influenza A(H1N1) 2009 and Other Influenza Viruses.2010 Feb. World Health Organization. WHO Guidelines for Pharmacological Management of Pandemic Influenza A(H1N1) 2009 and Other Influenza Viruses.2010 Feb.
25.
go back to reference Docherty AB, Harrison EM, Green CA, et al. Features of 20,133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985.CrossRefPubMedPubMedCentral Docherty AB, Harrison EM, Green CA, et al. Features of 20,133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985.CrossRefPubMedPubMedCentral
26.
go back to reference Bouadma L, Mekontso-Dessap A, Burdet C, et al. High-dose dexamethasone and oxygen support strategies in Intensive Care Unit patients with severe COVID-19 Acute Hypoxemic Respiratory Failure. JAMA Intern Med. 2022;182(9):906.CrossRefPubMedPubMedCentral Bouadma L, Mekontso-Dessap A, Burdet C, et al. High-dose dexamethasone and oxygen support strategies in Intensive Care Unit patients with severe COVID-19 Acute Hypoxemic Respiratory Failure. JAMA Intern Med. 2022;182(9):906.CrossRefPubMedPubMedCentral
27.
go back to reference Lee N, Allen Chan KC, Hui DS, et al. Effects of early corticosteroid treatment on plasma SARS-associated coronavirus RNA concentrations in adult patients. J Clin Virol. 2004;31(4):304–9.CrossRefPubMedPubMedCentral Lee N, Allen Chan KC, Hui DS, et al. Effects of early corticosteroid treatment on plasma SARS-associated coronavirus RNA concentrations in adult patients. J Clin Virol. 2004;31(4):304–9.CrossRefPubMedPubMedCentral
28.
go back to reference Dadras O, Afsahi AM, Pashaei Z, et al. The relationship between COVID-19 viral load and Disease severity: a systematic review. Immun Inflamm Dis. 2022;10(3):e580.CrossRefPubMed Dadras O, Afsahi AM, Pashaei Z, et al. The relationship between COVID-19 viral load and Disease severity: a systematic review. Immun Inflamm Dis. 2022;10(3):e580.CrossRefPubMed
29.
Metadata
Title
Relationship between glucocorticoids and viral load during the Omicron wave in mainland China
Authors
Guangxu Bai
Yan Li
Yang Liu
Xinming Wang
Xuezhong Yu
Lili Ren
Jun Xu
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Virology Journal / Issue 1/2023
Electronic ISSN: 1743-422X
DOI
https://doi.org/10.1186/s12985-023-02235-4

Other articles of this Issue 1/2023

Virology Journal 1/2023 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.