Login Register Cart 0
Generic placeholder image

Current Drug Safety

Editor-in-Chief

ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Evaluation of High-dose versus Standard-dose of Dexamethasone on Mortality among the Mechanically Ventilated COVID-19 Patients

Author(s): Pramodini B. Kale-Pradhan*, Regina Pacitto, Christopher A. Giuliano and Leonard B. Johnson

Volume 19, Issue 3, 2024

Published on: 13 September, 2023

Page: [350 - 355] Pages: 6

DOI: 10.2174/1574886318666230817102043

Price: $65

conference banner
Abstract

Introduction: Anti-inflammatory agents like dexamethasone (DEX) are a mainstay of treatment for COVID-19. Despite randomized trials demonstrating that a 6 mg daily dose of DEX improved patient outcomes in hospitalized COVID-19 patients receiving oxygen, clinicians often prescribe higher doses of corticosteroids without evidence to support this practice. The purpose of this study was to compare outcomes of ventilated COVID-19 patients who received standard dose (SD) versus high dose (HD) DEX.

Methods: This was a multi-site, retrospective, observational study on ventilated COVID-19- positive patients who received DEX for at least three days between June 1, 2020, and January 31, 2022. The primary outcome of this study was the association between mortality and SD (<6 mg daily) versus HD (>10 mg daily) DEX in ventilated COVID-19 patients. Secondary outcomes included average blood glucose (BG), number of BG readings above 200, incidence of bacterial nosocomial infection, ventilator-free days, length of stay (LOS), and ICU LOS.

Results: Of the 212 included patients, 53 (25%) received SD DEX, and 159 (75%) received HD DEX. There was no significant effect of DEX dose on mortality, number of BG readings >200, incidence of nosocomial infections, LOS, or ventilator-free days (p >0.05). After controlling for confounding factors, no difference in mortality persisted (OR 1.34 95% CI 0.62- 2.90). Average daily BG and ICU LOS were significantly greater in the HD group compared to the SD group (p = 0.003, p = 0.019, respectively).

Conclusion: There was no association between HD DEX and mortality among ventilated COVID- 19 patients compared to SD DEX. Moreover, HD DEX is associated with detrimental effects such as prolonged ICU LOS and higher average daily BG. This study supports the use of SD DEX in ventilated COVID-19 patients.

« Previous Next »
Graphical Abstract

[1]
Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020; 20(5): 533-4.
[http://dx.doi.org/10.1016/S1473-3099(20)30120-1]
[2]
National Institute of Health Therapeutic management of patients with COVID-19 COVID-19 treatment guidelines 2020. Available from: https://www.covid19treatmentguidelines.nih.gov/therapeutic-management/ (Accessed from:3 December 2020)
[3]
Horby P, Lim WS, Emberson JR, et al. Dexamethasone in hospitalized patients with COVID-19 - preliminary report. N Engl J Med 2021; 384(8): 693-704.
[PMID: 32678530]
[4]
Monedero P, Gea A, Castro P, et al. Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: A cohort study. Crit Care 2021; 25(1): 2.
[http://dx.doi.org/10.1186/s13054-020-03422-3] [PMID: 33397463]
[5]
Matthay MA, Wick KD. Corticosteroids, COVID-19 pneumonia, and acute respiratory distress syndrome. J Clin Invest 2020; 130(12): 6218-21.
[http://dx.doi.org/10.1172/JCI143331] [PMID: 32976118]
[6]
Monreal E, Sainz de la Maza S, Natera-Villalba E, et al. High versus standard doses of corticosteroids in severe COVID-19: A retrospective cohort study. Eur J Clin Microbiol Infect Dis 2021; 40(4): 761-9.
[http://dx.doi.org/10.1007/s10096-020-04078-1] [PMID: 33083917]
[7]
Bouadma L, Mekontso-Dessap A, Burdet C, et al. High-dose dexamethasone and oxygen support strategies in intensive care unit patients with severe COVID-19 acute hypoxemic respiratory failure. JAMA Intern Med 2022; 182(9): 906-16.
[http://dx.doi.org/10.1001/jamainternmed.2022.2168] [PMID: 35788622]
[8]
Maskin LP, Bonelli I, Olarte GL, et al. High- versus low-dose dexamethasone for the treatment of COVID-19-related acute respiratory distress syndrome: A multicenter, randomized open-label clinical trial. J Intensive Care Med 2022; 37(4): 491-9.
[http://dx.doi.org/10.1177/08850666211066799] [PMID: 34898320]
[9]
Munch MW, Myatra SN, Vijayaraghavan BKT, et al. The COVID STEROID 2 Trial Group. Effect of 12 mg vs 6 mg of dexamethasone on the number of days alive without life support in adults with COVID-19 and severe hypoxemia: The COVID STEROID 2 randomized trial. JAMA 2021; 326(18): 1807-17.
[10]
Taboada M, Rodríguez N, Varela PM, et al. Effect of high versus low dose of dexamethasone on clinical worsening in patients hospitalised with moderate or severe COVID-19 pneumonia: An open-label, randomised clinical trial. Eur Respir J 2022; 60(2): 2102518.
[http://dx.doi.org/10.1183/13993003.02518-2021] [PMID: 34916266]
[11]
Corral-Gudino L, Cusacovich I, Martín-González JI, et al. Effect of intravenous pulses of methylprednisolone 250 mg versus dexamethasone 6 mg in hospitalised adults with severe COVID ‐19 pneumonia: An open‐label randomised trial. Eur J Clin Invest 2023; 53(1): e13881.
[http://dx.doi.org/10.1111/eci.13881] [PMID: 36169086]
[12]
Wu H, Daouk S, Kebbe J, Chaudry F, Harper J, Brown B. Low-dose versus high-dose dexamethasone for hospitalized patients with COVID-19 pneumonia: A randomized clinical trial. PLoS One 2022; 17(10): e0275217.
[http://dx.doi.org/10.1371/journal.pone.0275217] [PMID: 36190994]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy