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BMC Infect Dis
. 2024 Feb 13;24(1):189.
doi: 10.1186/s12879-024-09056-y. Dexamethasone versus methylprednisolone for multiple organ dysfunction in COVID-19 critically ill patients: a multicenter propensity score matching study
Ohoud Aljuhani 1 , Ghazwa B Korayem 2 , Ali F Altebainawi 3 4 , Daniah AlMohammady 1 , Amjaad Alfahed 2 , Elaf F Altebainawi 5 , Mohammed Aldhaeefi 6 , Hisham A Badreldin 7 8 9 , Ramesh Vishwakarma 10 , Faisal E Almutairi 11 , Abeer A Alenazi 12 , Thamer Alsulaiman 13 , Rahaf Ali Alqahtani 7 , Fahad Al Dhahri 7 8 9 , Namareq Aldardeer 14 , Ahmed O Alenazi 15 , Shmeylan Al Harbi 7 8 9 , Raed Kensara 9 16 , Mai Alalawi 17 , Khalid Al Sulaiman 18 19 20 21
Affiliations
Background: Dexamethasone usually recommended for patients with severe coronavirus disease 2019 (COVID-19) to reduce short-term mortality. However, it is uncertain if another corticosteroid, such as methylprednisolone, may be utilized to obtain better clinical outcome. This study assessed dexamethasone's clinical and safety outcomes compared to methylprednisolone.
Methods: A multicenter, retrospective cohort study was conducted between March 01, 2020, and July 31, 2021. It included adult COVID-19 patients who were initiated on either dexamethasone or methylprednisolone therapy within 24 h of intensive care unit (ICU) admission. The primary outcome was the progression of multiple organ dysfunction score (MODS) on day three of ICU admission. Propensity score (PS) matching was used (1:3 ratio) based on the patient's age and MODS within 24 h of ICU admission.
Results: After Propensity Score (PS) matching, 264 patients were included; 198 received dexamethasone, while 66 patients received methylprednisolone within 24 h of ICU admission. In regression analysis, patients who received methylprednisolone had a higher MODS on day three of ICU admission than those who received dexamethasone (beta coefficient: 0.17 (95% CI 0.02, 0.32), P = 0.03). Moreover, hospital-acquired infection was higher in the methylprednisolone group (OR 2.17, 95% CI 1.01, 4.66; p = 0.04). On the other hand, the 30-day and the in-hospital mortality were not statistically significant different between the two groups.
Conclusion: Dexamethasone showed a lower MODS on day three of ICU admission compared to methylprednisolone, with no statistically significant difference in mortality.
Keywords: 30-day mortality; COVID-19; Critically ill; Dexamethasone; ICUs; In-hospital mortality; Methylprednisolone; SARS-Cov-2; Ventilation free days (VFDs).
. 2024 Feb 13;24(1):189.
doi: 10.1186/s12879-024-09056-y. Dexamethasone versus methylprednisolone for multiple organ dysfunction in COVID-19 critically ill patients: a multicenter propensity score matching study
Ohoud Aljuhani 1 , Ghazwa B Korayem 2 , Ali F Altebainawi 3 4 , Daniah AlMohammady 1 , Amjaad Alfahed 2 , Elaf F Altebainawi 5 , Mohammed Aldhaeefi 6 , Hisham A Badreldin 7 8 9 , Ramesh Vishwakarma 10 , Faisal E Almutairi 11 , Abeer A Alenazi 12 , Thamer Alsulaiman 13 , Rahaf Ali Alqahtani 7 , Fahad Al Dhahri 7 8 9 , Namareq Aldardeer 14 , Ahmed O Alenazi 15 , Shmeylan Al Harbi 7 8 9 , Raed Kensara 9 16 , Mai Alalawi 17 , Khalid Al Sulaiman 18 19 20 21
Affiliations
- PMID: 38350878
- DOI: 10.1186/s12879-024-09056-y
Background: Dexamethasone usually recommended for patients with severe coronavirus disease 2019 (COVID-19) to reduce short-term mortality. However, it is uncertain if another corticosteroid, such as methylprednisolone, may be utilized to obtain better clinical outcome. This study assessed dexamethasone's clinical and safety outcomes compared to methylprednisolone.
Methods: A multicenter, retrospective cohort study was conducted between March 01, 2020, and July 31, 2021. It included adult COVID-19 patients who were initiated on either dexamethasone or methylprednisolone therapy within 24 h of intensive care unit (ICU) admission. The primary outcome was the progression of multiple organ dysfunction score (MODS) on day three of ICU admission. Propensity score (PS) matching was used (1:3 ratio) based on the patient's age and MODS within 24 h of ICU admission.
Results: After Propensity Score (PS) matching, 264 patients were included; 198 received dexamethasone, while 66 patients received methylprednisolone within 24 h of ICU admission. In regression analysis, patients who received methylprednisolone had a higher MODS on day three of ICU admission than those who received dexamethasone (beta coefficient: 0.17 (95% CI 0.02, 0.32), P = 0.03). Moreover, hospital-acquired infection was higher in the methylprednisolone group (OR 2.17, 95% CI 1.01, 4.66; p = 0.04). On the other hand, the 30-day and the in-hospital mortality were not statistically significant different between the two groups.
Conclusion: Dexamethasone showed a lower MODS on day three of ICU admission compared to methylprednisolone, with no statistically significant difference in mortality.
Keywords: 30-day mortality; COVID-19; Critically ill; Dexamethasone; ICUs; In-hospital mortality; Methylprednisolone; SARS-Cov-2; Ventilation free days (VFDs).