The role of methylprednisolone on preventing disease progression for hospitalized patients with severe COVID-19

Eur J Clin Invest. 2020 Nov;50(11):e13412. doi: 10.1111/eci.13412. Epub 2020 Oct 2.


Background: COVID-19 is a public health emergency that is spreading worldwide and seriously affecting the global economy. Data on the effectiveness and safety of the use of methylprednisolone for patients with severe COVID-19 remain limited.

Methods: In this retrospective study, epidemiological, clinical, laboratory, treatment and outcomes data of hospitalized patients with severe COVID-19 in Zhongnan Hospital of Wuhan University from January 1 to 7 March 2020, were collected. Binary logistic regression model was used to analyse risk factors for disease progression from severe COVID-19 illness to critical illness. The effectiveness and safety of the use of methylprednisolone for patients with severe COVID-19 disease were evaluated.

Results: The results of the multivariate analysis from 175 patients with severe COVID-19 indicate that the use of methylprednisolone was a protective factor against disease progression from severe to critical illness(P < .001; OR: 0.054 95% CI: 0.017-0.173). Among patients with severe COVID-19 aged < 65 years, both the proportion of patients who progressed to critical illness (42.2% vs 90.0%, P = .000) and the mortality(6.7% vs 30.0%, P = .002) were lower for patients in methylprednisolone group, compared with those in the non-methylprednisolone group, whereas no statistical differences between the methylprednisolone group and the non-methylprednisolone group were found among patients with COVID-19 older than 65 years. Moreover, both the levels of CD4+ T lymphocyte counts (646 vs 463/µL, P = .007) and IL-6 (241.9 vs 82.8 pg/mL, P = .025) were higher among patients with severe COVID-19 aged < 65 years, compared with those patients ≥ 65 years old.

Conclusion: Data from the limited sample showed that the early use of low or medium doses of methylprednisolone has a positive effect for patients with severe COVID-19 younger than 65 years old, and excessive immune response and cytokine storm may be some of the reasons for the effectiveness.

Keywords: COVID-19; SARS-CoV-2; cytokine storm; methylprednisolone; prognosis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • COVID-19
  • COVID-19 Testing
  • Chi-Square Distribution
  • China / epidemiology
  • Clinical Laboratory Techniques
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / prevention & control*
  • Critical Illness / mortality
  • DNA, Viral / analysis*
  • Databases, Factual
  • Disease Progression
  • Female
  • Hospital Mortality*
  • Hospitalization / statistics & numerical data
  • Hospitals, University
  • Humans
  • Male
  • Methylprednisolone / therapeutic use*
  • Middle Aged
  • Pandemics / prevention & control*
  • Pandemics / statistics & numerical data
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / prevention & control*
  • Polymerase Chain Reaction / methods
  • Retrospective Studies
  • Risk Assessment
  • Survival Analysis


  • DNA, Viral
  • Methylprednisolone