Gainesville, FL—New research suggests that hospitalized COVID-19 patients should be discharged with prescriptions for steroids to help manage persistent systemic inflammation.

Researchers from the University of Florida in Gainesville suggests that inflammation contributes to negative health impacts months after apparent recovery from severe COVID-19. The same study team demonstrated last year that hospitalized patients who appear to have recovered from severe COVID-19 had more than twice the risk of dying within the next year compared to patients with only mild or moderate symptoms and who had not been hospitalized or who never had been infected.

The new study focused on severe systemic inflammation in those hospitalized patients. "COVID-19 is known to create inflammation, particularly during the first, acute episode. Our study is the first to examine the relationship between inflammation during hospitalization for COVID-19 and mortality after the patient has 'recovered'," explained first author Arch G. Mainous III, PhD, vice chair for research in the Department of Community Health and Family Medicine at the University of Florida.

"Here we show that the stronger the inflammation during the initial hospitalization, the greater the probability that the patient will die within 12 months after seemingly 'recovering' from COVID-19," Dr. Mainous added.

Researchers used deidentified electronic health records of 1,207 adults hospitalized in 2020 or 2021 after testing positive for COVID-19 within the University of Florida health system to track patients for at least a year after discharge. The concentration in blood of the molecule C-reactive protein (CRP), secreted by the liver in response to a signal by active immune cells, was used as a proxy for the severity of systemic inflammation during hospitalization.

The authors report that the results were as they expected: The blood concentration of CRP during hospitalization had a strong association with the severity of COVID-19. That measure was:

• 59.4 mg/L for hospitalized patients who did not require supplemental oxygen

• 126.9 mg/L for those who needed extra oxygen through noninvasive, nonmechanical ventilation

• 201.2 mg/L for the most severe cases who required ventilation through a ventilator or through extracorporeal membrane oxygenation.

The study calculated that COVID-19 patients with the highest CRP concentration measured during their hospital stay had a 61% greater adjusted hazard of dying of any cause within 1 year of discharge from the hospital than patients with the lowest CRP concentration. The results were also published in Frontiers in Medicine.

"Many infectious diseases are accompanied by an increase in inflammation," Dr. Mainous stated. "Most times the inflammation is focused or specific to where the infection is. COVID-19 is different because it creates inflammation in many places besides the airways, for example in the heart, brain, and kidneys. High degrees of inflammation can lead to tissue damage."

On the other hand, researchers noted that the elevated hazard of death from any cause associated with severe inflammation was lowered by 51% if the patient was prescribed anti-inflammatory steroids after their hospitalization.

The authors questioned whether greater use of long-term oral steroids upon discharge might be advisable to help combat the life-threatening inflammation.

They also suggested that COVID-19 might be considered a potential chronic disease. "When someone has a cold or even pneumonia, we usually think of the illness being over once the patient recovers. This is different from a chronic disease, like congestive heart failure or diabetes, which continue to affect patients after an acute episode," Dr. Mainous pointed out. "We may similarly need to start thinking of COVID-19 as having ongoing effects in many parts of the body after patients have recovered from the initial episode."

"Once we recognize the importance of 'long COVID' after seeming 'recovery', we need to focus on treatments to prevent later problems, such as strokes, brain dysfunction, and especially premature death," he added.

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