Outcomes of patients with severe and critical COVID-19 treated with dexamethasone : a prospective cohort study

Dexamethasone implementation for COVID-19 management represented a milestone but data regarding its impact and safety have not been consistently reproduced. We aimed to evaluate in-hospital mortality before and after the implementation of corticosteroid treatment (CS-T) for severe and critical COVID-19. We conducted a cohort study that included patients admitted with severe and critical COVID-19. The primary outcome was death during hospitalization. Secondary outcomes included the length of stay (LOS), need for invasive mechanical ventilation (IMV), time to IMV initiation, IMV duration, and development of hospital-acquired infections (HAIs). Bivariate, multivariate, and propensity-score matching analysis were performed. Among 1540 patients, 688 (45%) received CS-T. Death was less frequent in the CS-T group (18 vs 31%, p < .01). Among patients on IMV, death was also less frequent in the CS-T group (25 vs 55%, p < .01). The median time to IMV was longer in the CS-T group (5 vs 3 days, p < .01). HAIs occurred more frequently in the CS-T group (20 vs 10%, p < .01). LOS, IMV, and IMV duration were similar between groups. Multivariate analysis revealed an independent association between CS-T and lower mortality (aOR 0.26, 95% CI 0.19-0.36, p < .001). Propensity-score matching analysis revealed that CS-T was independently associated with lower mortality (aOR 0.33, 95% CI 0.22-0.50, p < .01). Treatment with corticosteroids was associated with reduced in-hospital mortality among patients with severe and critical COVID-19, including those on IMV.

Media Type:

Electronic Article

Year of Publication:

2022

Contained In:

Emerging microbes & infections - Vol. 11, No. 1 (2022), p. 50-59

Language:

English

Contributors:

Martinez-Guerra, Bernardo A
Gonzalez-Lara, Maria F
Roman-Montes, Carla M
Tamez-Torres, Karla M
Dardón-Fierro, Francisco E
Rajme-Lopez, Sandra
Medrano-Borromeo, Carla
Martínez-Valenzuela, Alejandra
Ortiz-Brizuela, Edgar
Sifuentes-Osornio, Jose
Ponce-de-Leon, Alfredo

Links:

Volltext

Keywords:

7S5I7G3JQL
Aged
COVID-19
Clinical Decision-Making
Comorbidity
Corticosteroids
Critical Illness
Dexamethasone
Disease Management
Female
Hospital Mortality
Hospitalization
Humans
Journal Article
Male
Mexico
Middle Aged
SARS-CoV-2
Severity of Illness Index
Treatment Outcome

Notes:

Date Completed 31.12.2021

Date Revised 07.01.2022

published: Print

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1080/22221751.2021.2011619

PMID:

34839785

PPN (Catalogue-ID):

NLM334919932