Hassan Alaa Thabet, Elmoniem Alaa E Abd, Abdelrady Marwa Mahmoud, Mohamed Mona Embarek, Mokhtar Mohamed A, Elsherif Abdelhalim A, Saied Ghada Mohamed, Kasem Soheir M
Chest Department, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt.
Internal and Critical Care Medicine Department, Faculty of Medicine, Assiut University, 71515 Assiut, Egypt.
Antibiotics (Basel). 2021 Oct 6;10(10):1214. doi: 10.3390/antibiotics10101214.
As COVID-19 has neither a standard treatment protocol nor guidelines, there are many treatment protocols for anti-inflammatory corticosteroids and anti-coagulations for severe COVID-19 pneumonia patients. This study aimed to assess the most suitable modality in this high-risk group.
A prospective, experimental study design was adopted that included 123 severe COVID-19 pneumonia patients admitted at Assiut University Hospital. Patients were divided into three groups according to a combined corticosteroid and anticoagulants therapy protocol. Group A included 32 patients, group B included 45 patients, and group C included 46 patients. Assessment of cases was conducted according to the treatment type and duration, weaning duration from oxygen therapy, length of hospital and ICU stay, and complications during treatment. Three months follow-up after discharge was performed.
the three patient groups showed significant differences regarding the 3-month outcome, whereas Group C showed the highest cure rate, lowest lung fibrosis, and lowest mortality rate over the other two groups. The in-hospital outcome, the development of pulmonary embolism, bleeding, hematoma, acute kidney disease, and myocardial infarction showed a significant difference between groups ( values < 0.05). Mortality predictors among severe COVID-19 patients by multivariable Cox hazard regression included treatment modality, history of comorbid diseases, increased C reactive protein, high neutrophil-lymphocyte ratio, and shorter ICU and hospital stay.
the use of combined methylprednisolone and therapeutic Enoxaparin, according to a flexible protocol for COVID-19 patients with severe pneumonia, had two benefits; the prevention of disease complications and improved clinical outcome.
由于新型冠状病毒肺炎（COVID-19）既没有标准治疗方案也没有指南，对于重症COVID-19肺炎患者，存在多种抗炎皮质类固醇和抗凝治疗方案。本研究旨在评估该高危人群中最合适的治疗方式。
采用前瞻性实验研究设计，纳入了123例在阿斯尤特大学医院住院的重症COVID-19肺炎患者。根据皮质类固醇和抗凝剂联合治疗方案将患者分为三组。A组包括32例患者，B组包括45例患者，C组包括46例患者。根据治疗类型和持续时间、氧疗脱机持续时间、住院和重症监护病房（ICU）住院时间以及治疗期间的并发症对病例进行评估。出院后进行了三个月的随访。
三组患者在3个月的预后方面存在显著差异，而C组在治愈率、肺纤维化程度和死亡率方面均优于其他两组。三组患者在院内结局、肺栓塞、出血、血肿、急性肾疾病和心肌梗死的发生情况方面存在显著差异（P值<0.05）。通过多变量Cox风险回归分析得出，重症COVID-19患者的死亡预测因素包括治疗方式、合并症病史、C反应蛋白升高、高中性粒细胞与淋巴细胞比率以及较短的ICU和住院时间。
对于重症肺炎COVID-19患者，根据灵活的方案使用甲泼尼龙和治疗性依诺肝素联合治疗有两个益处；预防疾病并发症并改善临床结局。
