Retrospective Analysis of the Glucocorticoid Treatment in 409 Patients with Severe Acute Respiratory Syndrome

Objective To analyze the effect of glucocorticoid on SARS patients. Methods The use of glucocorticoid in 409 SARS patients was reviewed. The patients were divided into different groups according to the dosage or the time of the glucocorticoid administration, then we analyze the symptoms, X-ray changing, CD4 + T cell values, oxygen given and the prognosis of these patients. Results In the ordinary type patients who were treated with glucocorticoid, the persistent time of the fever and the X-ray abnormality were longer, and the levels of he CD4 + T lymphocyte subset were lower than those who were not. Those who accepted mechanical ventilation were all in the groups using glucocorticoid, especially in the group in which methylprednisolone dosage reached more than 160mg/day. On the other hand, in the severe patients, the persistent time of the fever became longer when glucocorticoid was administrated after the 8th day from the onset of the disease. The persistent time of cough and short of breath was longer when methylprednisolone were more than 80mg/day. The use of glucocorticoid had no relations to the improvement of the X-ray. The patients who needed no oxygen given were almost in the group in which glucocorticoid were administrated during the three days from the onset of the disease. Those who treated with Methylprednisolone of 160mg/day had more tendency to be treated with mechanical ventilation. There was no correlation either between the initial time of the glucocorticoid treatment and the rate of mechanical ventilation, or between the initial time of the glucocorticoid treatment and the cure rate or the mortality rate in the severe patients. Nevertheless, the prognosis was much worse in the group of Methylprednisolone of 160mg/day. Conclusions The use of glucocorticoid can improve the oxygenation in some degree, but we still should hold the indication strictly.