Br J Clin Pharmacol . Dexamethasone use and Mortality in Hospitalized Patients with Coronavirus Disease 2019: a Multicenter Retrospective Observational Study

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Br J Clin Pharmacol


. 2021 Feb 19.
doi: 10.1111/bcp.14784. Online ahead of print.
Dexamethasone use and Mortality in Hospitalized Patients with Coronavirus Disease 2019: a Multicenter Retrospective Observational Study


Nicolas Hoertel ^{1 2 3} , Marina S?nchez-Rico ^{1 4} , Rapha?l Vernet ⁵ , Nathana?l Beeker ⁶ , Antoine Neuraz ^{7 8} , Jes?s M Alvarado ⁴ , Christel Daniel ^{9 10} , Nicolas Paris ^{9 11} , Alexandre Gramfort ¹² , Guillaume Lemaitre ¹² , Elisa Salamanca ¹³ , M?lodie Bernaux ¹⁴ , Ali Bellamine ¹⁵ , Anita Burgun ⁷ , Fr?d?ric Limosin ^{1 2 3}



Affiliations

• PMID: 33608891
• DOI: 10.1111/bcp.14784

Abstract

Aim: To examine the association between dexamethasone use and mortality among patients hospitalized for COVID-19.
Methods: We examined the association between dexamethasone use and mortality at AP-HP Greater Paris University hospitals. Study baseline was defined as the date of hospital admission. The primary endpoint was time to death. We compared this endpoint between patients who received dexamethasone and those who did not in time-to-event analyses adjusted for patient characteristics (such as age, sex, and comorbidity) and clinical and biological markers of clinical severity of COVID-19, and stratified by the need for respiratory support, i.e. mechanical ventilation or oxygen. The primary analysis was a multivariable Cox regression model.
Results: Of 12,217 adult patients hospitalized with a positive COVID-19 PT-PCR test, 171 (1.4%) received dexamethasone orally or by intravenous perfusion during the visit. Among patients who required respiratory support, the end-point occurred in 10/63 (15.9%) patients who received dexamethasone and 298/1,129 (26.4%) patients who did not. In this group, there was a significant association between dexamethasone use and reduced mortality in the primary analysis (HR, 0.46; 95%CI, 0.22 to 0.96, p=0.039). Among patients who did not require respiratory support, there was no significant association between dexamethasone use and the endpoint.
Conclusions: In this multicenter observational study, dexamethasone use administered either orally or by intravenous injection at a cumulative dose between 60 mg and 150 mg was associated with reduced mortality among patients with COVID-19 requiring respiratory support.

Keywords: Covid-19; SARS-CoV-2; dexamethasone; efficacy; mortality; oxygen; treatment; ventilation.