Goel Nitin, Goyal Nitesh, Nagaraja Ravishankar, Kumar Raj
Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi.
Monaldi Arch Chest Dis. 2021 Nov 3;92(2). doi: 10.4081/monaldi.2021.1981.
Some patients even 4 weeks after Corona Virus Disease 2019 (COVID-19) remain to be symptomatic and are known as "long-COVID". In the present study we performed the follow up evaluation at 3 months of long-COVID patients, after treatment with systemic steroids. During the study duration, out of the 4,542 patients managed in the outpatient department of the particular unit, there were 49 patients of Long-COVID. The patients having abnormal computed tomography (CT) alongwith resting hypoxia or exertional desaturation were treated with systemic steroid (deflazacort) in tapering doses for 8-10 weeks. We retrospectively analysed the clinical and radiological findings of these patients at first presentation and at about 3 months of follow up visit. On follow up, all the 49 long-COVID patients showed improvement. The occurrence of breathlessness decreased from 91.83% to 44.89% (p<0.001) and cough from 77.55% to 8.16% (p<0.001). Twenty-four patients were prescribed systemic steroids. Out of these, nearly 58% patients had MMRC grade 4 breathlessness, which decreased to < 2 MMRC in about 86% of these patients. MMRC grade (median) decreased from 3 to 1 (p<0.001). Majority of patients who were tachypnoeic and hypoxic at rest (n=7) showed improvement (71%), post-treatment with corticosteroids. Occurrence of normal chest X-ray increased from 12% to 71% (p<0.001). All these patients had abnormal CT thorax initially, and post-treatment 25% had normal CT thorax. Hence, we conclude that systemic steroids are helpful in hastening recovery of select subset of long-COVID patients. Simultaneously, we should be cautious of immunosuppressive effects of steroids like tuberculosis reactivation, especially in tuberculosis endemic countries. These findings have therapeutic implications and may serve as guidance for future approach to the management of 'long-COVID' with pulmonary sequalae.
一些患者即使在新型冠状病毒肺炎（COVID-19）感染4周后仍有症状，被称为“长新冠”。在本研究中，我们对接受全身类固醇治疗后的长新冠患者进行了3个月的随访评估。在研究期间，在该特定科室门诊管理的4542例患者中，有49例长新冠患者。计算机断层扫描（CT）异常且伴有静息性低氧或运动性血氧饱和度下降的患者接受了逐渐减量的全身类固醇（地夫可特）治疗8 - 10周。我们回顾性分析了这些患者首次就诊时以及随访约3个月时的临床和影像学表现。随访时，所有49例长新冠患者均有改善。呼吸困难的发生率从91.83%降至44.89%（p<0.001），咳嗽从77.55%降至8.16%（p<0.001）。24例患者接受了全身类固醇治疗。其中，近58%的患者有改良英国医学研究委员会（MMRC）4级呼吸困难，在这些患者中约86%的患者降至<2级MMRC。MMRC分级（中位数）从3降至1（p<0.001）。大多数静息时呼吸急促和低氧的患者（n = 7）在接受皮质类固醇治疗后显示出改善（71%）。胸部X线正常的发生率从12%增至71%（p<0.001）。所有这些患者最初胸部CT均异常，治疗后25%的患者胸部CT正常。因此，我们得出结论，全身类固醇有助于加速部分长新冠患者的康复。同时，我们应警惕类固醇的免疫抑制作用，如结核再激活，尤其是在结核病流行国家。这些发现具有治疗意义，可能为未来处理伴有肺部后遗症的“长新冠”提供管理指导。
