Use of Pulse Dose Methylprednisolone in a Cohort of very Severe Covid-19 Patients in a resource-limited setting in Myanmar: a retrospective study

Abstract

Aims: This study aims to explore the role of pulse dose methylprednisolone therapy in very severe COVID-19 patients in preventing the need for ICU care and death. Study design: Retrospective record review study Place and Duration of Study: Oak-ta-chat-thal-ta-pwint Covid-19 treatment center in Yangon, Myanmar between September 2021 to December 2021. Methodology: This study included 13 confirmed Covid-19 patients with severe to critical illness, who were treated with pulse dose methylprednisolone therapy. We reviewed the patients’ demographics, comorbidities and disease severity before starting pulse dose methylprednisolone therapy and changes in oxygen requirement, chest x ray scores, inflammatory markers, development of significant clinical events and 28 days mortality after therapy. Results: Before pulse dose methylprednisolone therapy, all 13 patients had very severe disease (mean SPO2/FiO2 = 173mmHg, mean SPO2 = 88.54%, mean CRP =115mg/L, mean ferritin = 1295.5ng/ml and mean Brixia Score = 6.54). They received 3-7 days (mean = 5.5) of pulse dose methylprednisolone. Ten patients (76%) survived in a setting with limited ICU care. High ferritin was a significant predictor of mortality. Improvement in oxygen requirement was noticeable after 1-11 days (mean =5.6g). Hyperglycemia was common and confirmed bacterial infection was found in 3 patients, but all patients received empirical antibiotics therapy. Conclusion: Pulse dose methylprednisolone therapy may be an effective salvage therapy in a carefully selected subset of very severe covid-19 patients. It might be a feasible alternative to other more expensive immunomodulating agents and organ support treatments in a resource-limited setting.