tetano
Editor, Senior Moderator
Eur Respir J
. 2021 Nov 25;2102532.
doi: 10.1183/13993003.02532-2021. Online ahead of print.
Dexamethasone in hospitalised coronavirus-19 patients not on intensive respiratory support
Kristina Crothers[SUP] 1 2 [/SUP], Rian DeFaccio[SUP] 3 [/SUP], Janet Tate[SUP] 4 [/SUP], Patrick R Alba[SUP] 5 [/SUP], Matthew Bidwell Goetz[SUP] 6 [/SUP], Barbara Jones[SUP] 5 [/SUP], Joseph T King Jr[SUP] 4 [/SUP], Vincent Marconi[SUP] 7 [/SUP], Michael E Ohl[SUP] 8 [/SUP], Christopher T Rentsch[SUP] 9 [/SUP], Maria C Rodriguez-Barradas[SUP] 10 [/SUP], Shahida Shahrir[SUP] 2 [/SUP], Amy C Justice[SUP] 4 11 [/SUP], Kathleen M Akgün[SUP] 4 [/SUP], Veterans Aging Cohort Study Clinical COVID-19 Working Group
Affiliations
Abstract
Introduction: Dexamethasone decreases mortality in coronavirus disease 2019 (COVID-19) patients on intensive respiratory support (IRS) but is of uncertain benefit if less severely ill. We determined whether early (within 48 h) dexamethasone was associated with mortality in patients hospitalised with COVID-19 not on IRS.
Methods: We included patients admitted to Veterans Affairs hospitals between June 7, 2020-May 31, 2021 within 14-days after SARS-CoV-2 positive test. Exclusions included recent prior corticosteroids and IRS within 48 h. We used inverse probability of treatment weights (IPTW) to balance exposed and unexposed groups, and Cox proportional hazards models to determine 90-day all-cause mortality.
Results: Of 19 973 total patients (95% men, median age 71, 27% black), 15 404 (77%) were without IRS within 48 h. Of these, 3514/9450 (34%) patients on no oxygen received dexamethasone and 1042 (11%) died; 4472/5954 (75%) patients on low-flow nasal cannula (NC) received dexamethasone and 857 (14%) died. In IPTW stratified models, patients on no oxygen who received dexamethasone experienced 76% increased risk for 90-day mortality (hazard ratio
1.76, 95% confidence interval [CI] 1.47 to 2.12); there was no association with mortality among patients on NC (HR 1.08, 95% CI 0.86 to 1.36).
Conclusion: In patients hospitalised with COVID-19, early initiation of dexamethasone was common and was associated with no mortality benefit among those on no oxygen or NC in the first 48 h; instead, we found evidence of potential harm. These real-world findings do not support the use of early dexamethasone in hospitalised COVID-19 patients without IRS.
. 2021 Nov 25;2102532.
doi: 10.1183/13993003.02532-2021. Online ahead of print.
Dexamethasone in hospitalised coronavirus-19 patients not on intensive respiratory support
Kristina Crothers[SUP] 1 2 [/SUP], Rian DeFaccio[SUP] 3 [/SUP], Janet Tate[SUP] 4 [/SUP], Patrick R Alba[SUP] 5 [/SUP], Matthew Bidwell Goetz[SUP] 6 [/SUP], Barbara Jones[SUP] 5 [/SUP], Joseph T King Jr[SUP] 4 [/SUP], Vincent Marconi[SUP] 7 [/SUP], Michael E Ohl[SUP] 8 [/SUP], Christopher T Rentsch[SUP] 9 [/SUP], Maria C Rodriguez-Barradas[SUP] 10 [/SUP], Shahida Shahrir[SUP] 2 [/SUP], Amy C Justice[SUP] 4 11 [/SUP], Kathleen M Akgün[SUP] 4 [/SUP], Veterans Aging Cohort Study Clinical COVID-19 Working Group
Affiliations
- PMID: 34824060
- DOI: 10.1183/13993003.02532-2021
Abstract
Introduction: Dexamethasone decreases mortality in coronavirus disease 2019 (COVID-19) patients on intensive respiratory support (IRS) but is of uncertain benefit if less severely ill. We determined whether early (within 48 h) dexamethasone was associated with mortality in patients hospitalised with COVID-19 not on IRS.
Methods: We included patients admitted to Veterans Affairs hospitals between June 7, 2020-May 31, 2021 within 14-days after SARS-CoV-2 positive test. Exclusions included recent prior corticosteroids and IRS within 48 h. We used inverse probability of treatment weights (IPTW) to balance exposed and unexposed groups, and Cox proportional hazards models to determine 90-day all-cause mortality.
Results: Of 19 973 total patients (95% men, median age 71, 27% black), 15 404 (77%) were without IRS within 48 h. Of these, 3514/9450 (34%) patients on no oxygen received dexamethasone and 1042 (11%) died; 4472/5954 (75%) patients on low-flow nasal cannula (NC) received dexamethasone and 857 (14%) died. In IPTW stratified models, patients on no oxygen who received dexamethasone experienced 76% increased risk for 90-day mortality (hazard ratio
1.76, 95% confidence interval [CI] 1.47 to 2.12); there was no association with mortality among patients on NC (HR 1.08, 95% CI 0.86 to 1.36).
Conclusion: In patients hospitalised with COVID-19, early initiation of dexamethasone was common and was associated with no mortality benefit among those on no oxygen or NC in the first 48 h; instead, we found evidence of potential harm. These real-world findings do not support the use of early dexamethasone in hospitalised COVID-19 patients without IRS.