An unprecedented research found an association between having an elevated inflammatory condition during the acute phase of hospitalization for Covid and a higher risk of death in the first year after hospital discharge.
In patients with severe Covid who had this inflammation in the body after infection with the coronavirus – known as a cytokine storm – and who required oxygen support or treatment to reduce inflammation, the risk of dying in the 12 months following infection was higher. 61% higher than in patients who had a moderate condition.
However, the study also found that treatment with anti-inflammatory drugs in the first 30 days after hospital discharge compared with those who did not use treatment was associated with a reduced risk of death by up to 51%.
The findings of the research carried out at the University of Florida in Gainesville (USA) were published in this Thursday’s edition (12) of the specialized journal Frontiers in Medicine.
To assess the risk of death up to 12 months after hospital discharge from Covid, researchers evaluated 1,207 patients over 18 years of age who were hospitalized between January 1, 2020 and December 31, 2021 with a confirmed diagnosis by RT-PCR exam for the Sars-CoV-2.
As an indication of inflammation during the acute phase of infection, the scientists evaluated the rate of C-reactive protein (CRP) in the blood, which is a compound naturally released in the body in the face of a cellular immune response.
Patients with a high CRP value during hospitalization were more likely to develop inflammation in other organs and die in the long term compared with those with a low CRP score (hazard ratio or HR=1.61). This risk was adjusted for other factors, such as age, gender and presence of comorbidities, which may also influence the outcome of Covid.
In the case of patients who were treated in the first months of 2020, before the pandemic was officially declared, the scientists considered that the hospitalizations corresponded to the profile of Covid and were later confirmed by laboratory examination.
In addition, the use of anti-inflammatory drugs for hospital treatment, such as intravenous or oral dexamethasone in the first days after hospital discharge, was also evaluated and was associated with a 46% higher risk ratio for death (HR=1). .46). As dexamethasone is used in the treatment of severe Covid in hospital, patients who received the drug consequently had high CRP values.
Thus, the researchers found that elevated inflammation in the initial phase was associated with the risk of dying up to a year after infection from any cause, including more serious sequelae in several organs of the body, but at the same time corticosteroid treatment decreased. this probability by half (HR=0.49).
According to Arch Mainous, a researcher at the University of Florida’s Department of Family and Community Health and coordinator of the study, the idea of making this comparison came first from observing how the risk of a new hospitalization up to a year after “recovering” from Covid was much higher in people who had severe disease.
“As we had already observed hospitalization as a determining factor for having long-term Covid in phases 1 and 2 of our study, we sought to assess the differences between those who had high inflammation in the hospitalization phase, indicated by the CRP rate, compared with those who had high inflammation in the hospitalization phase, indicated by the CRP rate. moderate patients. And that’s when we saw that the association of severity with high inflammatory response is clear”, he told Sheet.
For Mainous, intravenous dexamethasone has a role, during the acute phase of Covid, of helping lung function and, as a side effect, reducing inflammation, unlike oral treatment after discharge, which is only indicated as an anti-inflammatory agent. “What we’ve seen is that people who are prescribed oral corticosteroids in the first few days after hospital discharge have a lower risk of death,” she explained.
The thousands of deaths directly linked to Covid, says the doctor, can also be added to all those that occurred one year after recovery from the acute phase and that, according to him, were not evaluated as a long-term effect of the disease, but other causes. not related to Covid. “We are not focusing on these potential deaths, the focus is always on the acute phase, on treating and recovering people and getting them out of the hospital, but what we saw is that this is the first step, there is a chronic phase of Covid to be treated. too,” he said.
According to him, however, the research is not intended to say that everyone should receive a prescription for the drug. “It is not to say that everyone should use corticosteroids, but with our finding we hope that further trials will be conducted to evaluate other drugs and calculate the potential effects of chronic inflammation in patients after discharge from Covid”, he pointed out.