The following article focuses on the possible role of corticosteroids in the management of COVID-19 infection and its symptoms.
Cytokine release syndrome(CRS) is one of the mechanisms COVID-19 causes
ARDS, myocarditis, myocardial injury and MODS.
The mechanism of COVID-19 related CRS is similar to secondary HLH(hemophagocytic
lymphohistiocytosis) that causes MODS.
In the US IL-6 assays are used to know the onset of CRS and then tocilizumab is used. Corticosteroids may be used to inhibit this cytokine release . As lymphocytes release cytokines, it is possible to track the lymphocyte trend by performing a CBC twice a day. The point at which
lymphocytopenia turns into lymphocytosis, is the time; if given methylprednisolone 1 mg/kg ODx3 for 5 days, can we inhibit the cytokine storm, MODS and crashing.
Even in cases of COVID-19, steroids are allowed by guidelines to be used in septic
shock and other indications like acute exacerbation of asthma and COPD. What
allows steroids here and what precludes its use in other contexts of COVID-19?
As COVID-19 is novel, it is unsure whether steroids can be given or not. No direct data or indirect data from SARS, MERSCov and H1N1 shows that it’s not useful or even harmful.
They were given in full blown ARDS and that might be the reason for its failure.
In this article, it is recommended to give it preemptively at that juncture where the lymphocytopenia changes into lymphocytosis.
A CBC every 6hr to identify the lymphocytosis early can be performed.
No doubt monitoring IL-6 is ideal and then using its antagonist tocilizumab but in resource
poor countries like India is it possible to use the onset of lymphocytosis as surrogate to IL-6
assay and the use of corticosteroids in place of tocilizumab?