This prospective cohort study included patients who survived hospitalization for COVID-19-associated hyperinflammation. Between March and May 2020, patients hospitalized for COVID-19-associated hyperinflammation in the Zuyderland Medical Centre (ZMC), a large teaching hospital in the Netherlands, were included in the COVID High-intensity Immunosuppression in Cytokine storm syndrome (CHIC) study [14 (link)]. COVID-19-associated hyperinflammation was defined according to a set of criteria: oxygen saturation at rest ≤ 94% or tachypnoea (> 30/min); at least two out of three biomarker criteria: CRP > 100 mg/L, serum ferritin > 900 µg/L at one occasion or a twofold increase of the level at admission within 48 h and D-dimer level > 1500 µg/ [14 (link)]. From March 1st to April 1st 2020, patients were treated with standard of care (control group), consisting of oxygen support, antibiotics, chloroquine and anticoagulation. After April 1st, patients were treated according to the CHIC protocol, which was added to standard of care (treated group). This protocol included two steps: (1) intravenous methylprednisolone 250 mg on day 1, followed by methylprednisolone 80 mg intravenously on days 2–5, and an option for a two-day extension; (2) addition of tocilizumab (single dose, 8 mg/kg body weight intravenous, max 800 mg) in case of lack of improvement or worsening in respiratory status 48 h after starting with methylprednisolone. Results confirming the benefits of this therapeutical strategy during the acute setting of COVID-19-associated hyperinflammation have been published [14 (link)]. All survivors of this study were invited for an ambulatory follow-up visit at the Pulmonology department of ZMC. Patients were excluded if they were unable to visit the outpatient clinic.
Approval was obtained by the Medical Ethical Committee (METC) and the Board of ZMC, the Netherlands (number METCZ20200126). All patients provided written informed consent for the use of their data for this study.
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