Steroid Treatment Balance According To The Lymphocyte / White Blood Cells Ratio In COVID-19 Patients, A Retrospective Cohort Analysis

  1. Ferhat Arslan
  2. Ali Mert
  3. Mehmet Bayram
  4. Handan Ankaralı
  5. Haluk Vahaboglu

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Abstract

Objectives

Progressive respiratory failure is the main cause of clinical worsening in Coronavirus disease (COVID-19) patients. The decision to intubate during the follow-up of COVID-19 patients is critical because of high mortality rates.

Methods

We analyzed the COVID-19 related intubation and in-hospital mortality risk factors of patients admitted to two tertiary hospitals.

Results

Of the 275 patients included in the study, 44 (16%) were intubated, while 30 of them were patients (53%, 30/56) who had previously received steroid therapy. In 23 patients (77%) who received steroid therapy and were intubated, antiviral therapy was started in the first 6 days and Lymphocyte / White blood cells (LYM/WBC) ratios were lower than 0.18. The LYM/WBC ratio was found to be less than 0.12 in 14 patients who were intubated but did not receive steroid treatment before. 30(11%) of the patients included in the study died. While the number of deaths among those who did not receive steroid treatment was 10 (5%), it was 20 (36%) among the patients who did. Among in these 20 patients, it was observed that all 9 people who started antiviral treatment before 3 days, who were over 57 years old and whose oxygen saturation result was moderate or severe, died.

Conclusions

We think that the use of steroids in early period may be detrimental in rapidly progressive patients with lymphopenia that may be an independent marker of immune dysregulation.

Box-ED Section

What is already known on the study topic?

Progressive respiratory failure is the main cause of clinical worsening in COVİD-19 patients. Corticosteroid treatment has remarkable favourable effect on the prognosis.

What is the conflict on the issue? Has it importance for readers?

Corticosteroids is immunosupresive drug that have also nonspesific antienflammatory effect. Clinicians must consider multiple parameters such as patient status, disease period and existence of bacterial superinfection when to start corticosteroid treatment at bedside.

How is this study structured?

We conducted a retrospective study to analyze risk factors COVID-19 related intubation two cohorts. This study included patients diagnosed with COVID-19 induced pneumonia from March 21 to Apr 23,2020, at two university hospitals located on distinct sides of Istanbul province in Turkey.

What does this study tell us?

We think that the use of steroids in early period may be detrimental in rapidly progressive patients with lymphopenia that may be an independent marker of immune dysregulation

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  1. ScreenIT

    SciScore for 10.1101/2022.02.16.22271033: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The ethics committee of the Istanbul Medipol University approved this study (No: 10840098-604.01.01-E.14713).
    Consent: Ethics committee waived obtaining informed consent.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    SPSS (ver. 23)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.02.16.22271033v1 on medRxiv