A total of 29 ICU patients with intermediate or severe COVID-19 pneumonia recruited in this study. Patients randomly assigned to the investigation and control group, 14 patients (4 female, ten male) allocated in the investigation group, and 15 patients (6 female, nine male) assigned to the control group. The participant’s average age was 64.03 ± 13.545 (case: 61.07 ± 12.83, control: 66.80 ± 14.03).
Oxygen therapy, antiviral therapy (Kaletra [lopinavir/ritonavir]), prevention of bacterial infection, and nutritional support were administered for all 29 patients. While the case group received methylprednisolone pulse with the dosage of 1000 mg/ day for three days via intravenous injection. There was no mortality among the patients receiving the methylprednisolone treatment, but the mortality was high in patients without methylprednisolone therapy.
The mean systolic blood pressure (SBP) at rest was significantly (P-Value:0.018) higher among patients with methylprednisolone pulse therapy compared to the control group on admission day and remained higher on following ten days. The daily mean SBP of the two groups shown in Fig. 1. Patients with methylprednisolone therapy had a mean SBP of 115 mmHg on admission day, which raised steadily to 125 mmHg on the tenth day. Meanwhile, patients without methylprednisolone had a mean SBP of 105 on admission day, which fluctuated on the following ten days and reached to 120 mmHg on the sixth day but finally returned to 105 mmHg on the tenth day.
The mean diastolic blood pressure (DBP) at rest was significantly (P-Value: 0.001) higher among patients with methylprednisolone pulse therapy on admission day, mean DBP of patients with methylprednisolone stayed constant on 80 mmHg with a little fluctuation but the mean DBP of patients without methylprednisolone raised from 70 mmHg to 80 mmHg with intense fluctuation in following ten days. The daily mean DBP of case and control groups shown in Fig. 2.
The mean FiO2 administered for patients with or without methylprednisolone pulse therapy on admission day was similar, due to low SpO2, all the patients with or without methylprednisolone therapy received oxygen therapy. The daily mean FiO2 administered and SpO2 of patients in case and control group are shown in Fig. 3 and Fig. 4, respectively. As shown in Fig. 3, FiO2 needed for patients with methylprednisolone therapy dropped steadily from approximately 90–50%, and the need for Positive end-expiratory pressure (PEEP) declined from 10 cmH2O to 5 cmH2O as shown in Fig. 5. In addition to improvement of respiratory outcome in methylprednisolone group, Glasgow Coma Scale (GCS) of methylprednisolone group significantly (P-Value < 0.001) improved since the administration of methylprednisolone as presented in Fig. 6 (mean GCS of 15 in methylprednisolone group versus GCS of lower 10 in the control group)
The laboratory parameters, including CPK, LDH, and SrCr, were significantly (CPK, P-Value = < 0.001, LDH, P-Value = 0.003, SrCr, P-Value = < 0.001) different among patients with and without methylprednisolone group. Both mean CPK and mean LDH decreased through 10 days follow up, but drop and fluctuation of these measures were more intense in the control group (Fig. 7, Fig. 8). Moreover, there was no significant difference in trends of mean Total and Direct bilirubin among the case and control groups.
Assessment of patient’s Chest CT-scan pretreatment (Fig. 9) and 3 days post treatment (Fig. 10) in ICU revealed the significant clearance of Chest scan from patchy ground-glass lesions without any trace of fibrosis in patients receiving the methylprednisolone while there were no evidence of recovery in chest CT-scan of the control group.