الفهرس 
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Abstract
Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by the SARS-CoV-2 (WHO, 2020). Although most patients present a mild-moderate disease, almost one-third of patients are at high risk of developing a more severe disease due to an (ARDS) that may lead to the need for (MV) and admission to an ICU, or even death. (Wu C, et al, 2020)
The underlying mechanisms of severe COVID-19 are related to systemic inflammatory responses that can lead to lung injury and multisystem organ dysfunction (Wu C, et al, 2020) & (Vardhana SA et al, 2020). Based on this assumption, systemic anti-inflammatory drugs have been proposed as an alternative treatment tool to avoid the SARS-CoV-2-induced inflammatory state and to reduce mortality in these patients. (Vardhana SA et al, 2020) & (Fu Y et al, 2020)
This prospective observational study was conducted on 61 patients diagnosed to have Corona virus pneumonia proven via COVID-19 polymerase chain reaction (PCR) test or having chest CT findings matching COVID-19 pneumonia (CORADS 4-5) admitted to the chest department ICU in Beni-Suef university hospital of both sexes.
The patients were divided randomly into two groups,
• The first group (group 1): 30 patients that received low dose methylprednisolone (200 mg daily) from the start of the therapy.
• The second group (group 2): 31 patients that received high dose of methylprednisolone (500 mg for three consecutive days then reduced to usual dose 200mg daily).
Both groups received the usual treatment of such cases, The patients oxygen requirements was followed up for 5 days Na, k, blood pressure, random blood sugar, conscious level, arrhythmias, AST ,ALT, and serum creatinin were measured on admission and at the fifth day of treatment. Patient’s oxygen requirement was noted on discharge. Intensive care unit stay, need of mechanical ventilation, mortality and complications (e.g. bacterial or fungal infections) were followed up till the patients discharge or 21 day from the admission date.
This study revealed that:
• There were higher means of CRP (95.30 ±44.61in LDC vs, 117.52 ±57.46 in HDC), D-DIMER (738.00 ±659.89 in LDC vs 924.00 ±776.65 in HDC) ferritin (588.10 ±344.82 in LDC VS 660.10 ±258.63 in HDC) than normal range.
• On comparing the pre- and post-treatment laboratory data:
a) CRP was significantly decreased in the HDC group (117.52 ±57.46 vs. 69.58 ±52.56; p=0.001), in pre- and post-treatment assessment respectively. D-Dimer increased significantly in both studied groups in pre- and post-treatment assessment. TLC increased significantly in LDC group (8.79 ±4.93 vs 12.14 ±6.78, p=0.015), however in HDC group TLC was increased but with no statistical significance (p-value >0.5).
b) Creatinin was significantly decreased in the LDC group (1.22 ±0.83 vs. 1.08 ±0.84; p=0.007), however in HDC group creatinin was slightly increased but with no statistical significance (p-value >0.5). Urea was significantly increased in the HDC group (51.10 ±21.64 vs. 61.32 ±30.50; p=0.014), however in LDC group urea level was slightly increased but with no statistical significance (p-value >0.5).
c) RBCs and serum Na increased significantly in both studied groups.
d) ALT was significantly increased in the LDC group (45.97 ±37.32 vs. 52.60 ±43.68; p=0.013), however in HDC group ALT was slightly increased but with no statistical significance (p-value >0.5).
e) Ferritin, potassium and AST showed non-statistically significant change among the two studied groups, (p-values >0.05)
f) Blood (pH) showed non-statistically significant changes in both studied groups. While in both treatment groups, there was a statistically significant increase in PaO2, PaCO2 and SaO2, while regarding HCO3, there was a statistically significant increase in LDC group as compared to a slight non-statistically significant increase in HDC group (p-value= 0.070).
• In this study there was non-statistically significant difference between the two groups regarding the need of NIV (46.7% in LDC VS 51.6% in HDC, P=0.448) and duration of NIV p-value (0.931) with average duration (8.36 ±4.40 in the LDC VS, 8.50 ±4.53 in HDC).
• In this study, the need of mechanical ventilation didn’t differ statistically ;( p=0.463), between the two groups (36.7% in LDC vs 32.3% in HDC and also the duration of mechanical ventilation :( p-value =0.863) with average duration (5.27 ±2.41 in LDC vs , 5.10 ±2.08 in HDC).
• Regarding the type of oxygen therapy no statistically significant difference was found: p-value (0.111).
• Also hospital and ICU stay, didn’t differ significantly (p-value= >0.05), with average duration of hospital stay (13.03 ±6.93, 14.97 ±5.36 in the LDC &HDC respectively )and average duration of ICU stay (13.20 ±6.82 , 15.00 ±5.34 in the LDC & HDC respectively).
• in our study there was no statistically significant difference between the studied groups as regards treatment complications (hypertension, infection, acute renal failure and arrhythmia) while there was statistically significant difference between both treatment group as regards the occurrence of hyperglycemia, the prevalence of hyperglycemia was higher among HDC than LDC group (61.3% vs 16.7%), respectively at p=0.001.).
• In this study there was non-statically significant difference between the two groups regarding the mortality rate.
• There was no relation between the dose of methylprednisolone and the mortality rate, while advanced age, increased APATACHE II Score, need of NIV, need of MV, and infection were associated with increased mortality rate.