Demographics and baseline characteristics
The demographic and clinical characteristics of the patients are summarized in Table 1. Seventy-five patients with severe COVID-19 were included in this study. The mean age was 58.92 ± 14.29 years, and 39 (52%) patients were male. Of the 75 patients, 47 (62.7%) were administered corticosteroids and were therefore classified into the corticosteroid group, whereas 28 (37.3%) were not administered corticosteroids and were therefore classified into the non-corticosteroid group. All the 47 patients in the corticosteroid group received corticosteroids use within 72 hours of severe COVID-19 diagnosis. The symptoms of COVID-19 in the included patients were fever (61.33%), cough (76%), dyspnea (53.33%), sputum production (34.67%), and weakness (29.33%). There were no statistically calculated differences between the two groups of patients in terms of gender, age, smoking, APACHE II score, hypertension, diabetes, CAD, COPD, cerebrovascular disease, viral hepatitis, neoplastic disease, CKD, fever, cough, sputum, weakness, headache, diarrhea, shock, leukopenia, thrombocytopenia, liver dysfunction, AKI, or cardiac injury, as displayed in Table 1.
Treatments and outcomes in patients with severe COVID-19
Approximately eighty-three percent of the patients (62/75) received antibiotic therapy, and 12 (16%) of the patients received antifungal therapy. Sixty three patients (84%) received thymopentin or thymalfasin, and 30 patients (42.76%) received intravenous injection (IV) immunoglobulin. 28 patients (37.33%) received non-invasive ventilation (NIV), 7 patients (9.33%) received invasive ventilation, and three patients (4%) received ECMO therapy.
In the corticosteroid group, the vast majority of enrolled patients (95.74%) received antibiotics, and 25.53% of the patients received antifungal therapy; the proportion of those patients receiving antibiotics and antifungals was significantly higher in the corticosteroid group compared to the non-corticosteroid group (p <0.05). Nevertheless, we found no differences between the two groups in the total LOS, the length of ICU stay, the high-flow oxygen days, the NIV days, the invasive ventilator days, and the mortality rate, as indicated in Table 2.
Comparison of laboratory variables
There were no significant differences in APACHE II scores between the corticosteroid group and the non-corticosteroid group on D 0 or D14. Moreover, the APACHE II score significantly decreased in each of the two groups from D 0 to D14 (p <0.05), as shown in Table 3.
We did not observe a significant difference in the oxygenation index between the corticosteroid group and the non-corticosteroid group on D 0 or D14. In addition, the oxygenation index in each of the two groups significantly increased from D 0 to D14 (p <0.05).
At the same time, we found that inflammatory indicators at baseline (e.g., CRP, PCT, WBC, D-dimer, IL-6, and IL-10) and some serum biochemical indicators were no significant differences in those indicators between the two groups on D 0 or D14.
Some inflammatory factors in corticosteroid group, including D-dimer, IL-10, increased over time, while CRP decreased significantly from D 0 to D14 ( p <0.05). And some inflammatory factors in the non-corticosteroid group, including PCT, CRP, IL-10, decreased significantly from D 0 to D14 (p <0.05).
Subsequently, compared with the non-corticosteroid group, we found that CD4+, but not CD8+ T-cell counts were significantly decreased in both groups from D 0 to D14 (p <0.05). This is illustrated in detail in Table 3.
The results of imaging evaluation in patients with COVID-19
Table 4 shows the results of imaging evaluations in each group of patients with severe COVID-19. We found that the common chest CT features of COVID-19 patients mainly included consolidation, GGOs, and linear opacities. The total lesion volume ratio, consolidation volume ratio, and GGO volume ratio were significantly higher in the corticosteroid group than in the non-corticosteroid group on D 0 (p <0.05). However, there was no significant difference in these indicators between the two groups on D14 (p >0.05). This is illustrated in Fig 1.
We found that total lesion volume ratio and GGO volume ratio in both groups decreased over time, while total lesion volume ratio and GGO volume ratio in the corticosteroid group decreased significantly on D14, which is different with that in the non-corticosteroid group. However, unlike patients in the corticosteroid group, whose consolidation volume ratio decreased significantly on D14, we found that the consolidation volume ratio in the non-corticosteroid group increased significantly on D14.