Steroid Treatment Balance According To The Lymphocyte / White Blood Cells Ratio In COVID-19 Patients, A Retrospective Cohort Analysis

ObjectivesProgressive respiratory failure is the main cause of clinical worsening in Coronavirus disease (COVID-19) patients. The decision to intubate during the follow-up of COVID-19 patients is critical because of high mortality rates. MethodsWe analyzed the COVID-19 related intubation and in-hospital mortality risk factors of patients admitted to two tertiary hospitals. ResultsOf the 275 patients included in the study, 44 (16%) were intubated, while 30 of them were patients (53%, 30/56) who had previously received steroid therapy. In 23 patients (77%) who received steroid therapy and were intubated, antiviral therapy was started in the first 6 days and Lymphocyte / White blood cells (LYM/WBC) ratios were lower than 0.18. The LYM/WBC ratio was found to be less than 0.12 in 14 patients who were intubated but did not receive steroid treatment before. 30(11%) of the patients included in the study died. While the number of deaths among those who did not receive steroid treatment was 10 (5%), it was 20 (36%) among the patients who did. Among in these 20 patients, it was observed that all 9 people who started antiviral treatment before 3 days, who were over 57 years old and whose oxygen saturation result was moderate or severe, died. ConclusionsWe think that the use of steroids in early period may be detrimental in rapidly progressive patients with lymphopenia that may be an independent marker of immune dysregulation. Box-ED SectionO_ST_ABSWhat is already known on the study topic?C_ST_ABSProgressive respiratory failure is the main cause of clinical worsening in COV[I]D-19 patients. Corticosteroid treatment has remarkable favourable effect on the prognosis. What is the conflict on the issue? Has it importance for readers?Corticosteroids is immunosupresive drug that have also nonspesific antienflammatory effect. Clinicians must consider multiple parameters such as patient status, disease period and existence of bacterial superinfection when to start corticosteroid treatment at bedside. How is this study structured?We conducted a retrospective study to analyze risk factors COVID-19 related intubation two cohorts. This study included patients diagnosed with COVID-19 induced pneumonia from March 21 to Apr 23,2020, at two university hospitals located on distinct sides of Istanbul province in Turkey. What does this study tell us?We think that the use of steroids in early period may be detrimental in rapidly progressive patients with lymphopenia that may be an independent marker of immune dysregulation