Doctor warns of higher mortality risk from steroid therapy

By Shan Juan (China Daily)
Updated: 2010-01-07 07:03
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A risk posed by steroid therapy that crippled hundreds of patients of the 2003 SARS outbreak in China seems to have emerged in the current treatment regime for the H1N1 pandemic flu.

Overuse of the steroid glucocorticoid to treat critically-ill H1N1 patients has, in many cases, worsened their condition, even leading to deaths after weakening their immunity, warned Li Ning, president of Beijing Youan Hospital, one of the two government-designated hospitals to treat severe H1N1 cases.

So far, 15 of the 49 serious H1N1 patients have died at the hospital, including two pregnant women, said Li.

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All the dead had received steroids before being admitted to Youan, said Li, who does not use that line of treatment.

Most of the victims had been given steroid therapy in high doses ranging from 300 mg to 1,200 mg.

The mortality among those who had earlier received high doses of steroid reached 70 percent at the Beijing hospital, twice that among those who did not use steroids, Li noted.

As of Jan 2, China had recorded more than 120,000 H1N1 flu cases including 659 deaths.

Many questions concerning steroid therapy remain, such as its efficacy, and when or how long to use it, Li said, suggesting "it should not be employed in H1N1 treatment".

Zhong Nanshan, a Guangzhou-based doctor famous for exposing a cover-up of the SARS epidemic and who initiated steroid therapy in China then, thinks otherwise.

"The samples at Youan Hospital are not enough to draw the conclusion," he told China Daily yesterday, but conceded that improper use of the therapy could cause problems.

"Random use of steroids in all severe SARS or H1N1 patients is definitely wrong," he said.

"But the right use of steroids in terms of timing, duration and dosage is definitely effective for the treatment of severe SARS and H1N1 patients," he said.

Zeng Guang, chief epidemiologist at the Chinese Center for Disease Control and Prevention, said critically-ill SARS and H1N1 patients suffering respiratory failure could die without steroid treatment.

"Given known side effects from steroid treatment like bone degeneration, hypertension and even cancer, the right use of the steroid remains a tough choice facing not only China but the world, " he said.

Internationally, there is no published evidence demonstrating an improvement in morbidity or mortality with steroid treatment in SARS or H1N1.

However, clinicians turn to it as a last resort for treating H1N1 patients, according to media reports.

Current WHO clinical management guidance does not include steroid therapies for the management of H1N1 in general.

"The use of hormonal therapies should be determined on an individual basis," said Vivian Tan, press officer of the organization's Beijing office.

In the latest H1N1 treatment guidelines issued by the Ministry of Health, steroid therapy is not recommended.

However, the previous one did recommend it for treating H1N1 cases where patients have breathing difficulty.

"It's a double-edged sword which can both save and harm or even kill," Li said, citing the plight of some SARS survivors suffering from avascular necrosis because of high doses steroid treatment.

"In Beijing alone, more than 300 SARS survivors suffer from the disease," Li noted.

"The lesson should be learnt, particularly in H1N1 treatment," he said.

During the SARS outbreak, high dose steroid therapy was widely used. Roughly 30 percent of SARS survivors in China who received the therapy have developed severe bone degeneration, according to Chen Weiheng, a leading bone specialist in Beijing.

In 2003, SARS infected more than 8,000 people worldwide. China was the worst hit with more than 300 SARS-related deaths and 5,000 infections.