PURPOSE: To explore the effectiveness of glucocorticosteroids (GCS) in the treatment of SARS and to determine the appropriate dose.
METHODS: All Probable SARS cases in Beijing during 2003 were reviewed along with SARS CoV antibody detection or virus isolation. The GCS dose was changed into that of methylprednisolone. Single factor and Logisitc multifactor regression analysis were performed.
RESULTS: 1125 cases fulfilled the criteria of Confirmed SARS and 150 were rule out. The mortality of Confirmed SARS cases was 2.2% and 0% for excluded cases (p=0.0000). SARS confirmed cases accepted a high proportion of larger GCS treatment(p<0.0001).Those died had higher age(p<0.0001), temperature(p=0.0354), heart rate(p=0.0256), chest film scale(p=0.0014) and lower peripheral lymphocytes counts at the first vist(p=0.0024), the oxygen index(p=0.0005), lymphocytes percentage(p<.0001) and count (p<.0001) before GCS use. Lymphocytes and its T subsets were decreased gradually until the initiation of GCS. In severe cases, the mortality rate for<80mg/d of mean dose was 0.8%, 4.3% for 80∼159mg/d, 12.7% for 160∼319mg/d,55.6% for ≥320/mg/d and 4.6% for non-GCS group(p<0.001).Based on Logistic multifactor regression analysis, the mean dose of <80mg/d had the lowest RR compared with non-GCS group(0.077,95%CI:0.007∼0.907, p=0.0416). RR of 80∼159mg/d was 0.994(p=0.9943)and 160∼319mg/d 3.940(p=0.1084). ≥320/mg/d significantly increased the RR(23.217p=0.0011). As compared with initial dose <160mg/d and mean dose <80mg/d, RR of initial dose <160mg/d and mean dose≥80mg/d was 49.707(p=0.0017). RR of initial dose≥160mg/d and mean dose≥80mg/d was 46.143(p=0.0021).Initial dose ≥160mg/d and mean dsoe <80mg/d had the lowest RR but without significance.
CONCLUSION: High dose GCS was widely used int the treatment of SARS in Beijing. The mean dose less than 80mg/d could reduce the fatality risk. The suitable mode for GCS use is a larger initial dose with a subsequently rapid reduction to a lower maintenance dose. High maintenance doses should be avoided.
CLINICAL IMPLICATIONS: From the study, we could know that GCS could be used in the treatment of SARS. The dose recommended is less than 80mg of methylprednisolone. This experience could be helpful to the treatment of other virus pneumonia.
DISCLOSURE: Guangfa Wang, No Financial Disclosure Information; No Product/Research Disclosure Information