Articles

Dexamethasone Treatment in Patients With Severe COVID-19: A Propensity Score-Matched Study

Abstract

During the coronavirus disease-2019 (COVID-19) pandemic, which was caused by the novel coronavirus, there is an ongoing controversy about the use of corticosteroids. This study aims to investigate the association between Dexamethasone treatment and clinical outcomes in patients with severe COVID-19. In this single-center retrospective cohort study, patients with COVID-19 were enrolled from February 16, 2020, to November 1, 2020. After performing propensity score matching with age, sex, and disease severity. The independent effect of Dexamethasone treatment on in-hospital mortality was evaluated by multivariate proportional hazards regression models. Of 1413 patients with COVID-19 diagnosis, 1172 patients entered the final analysis. 473(40.4%) patients received dexamethasone treatment with a median duration of 6.0[4.0-9.0] days. After matching and adjustment with possible confounders in the multivariate model, administration of dexamethasone significantly increased the survival in severe patients (hazard ratio: 0.25, 95 confidence intervals: 0.16-0.38, P<0.001), but there was no difference in non-severe patients (P:0.888). The administering of dexamethasone was associated with an increased in-hospital survival rate (HR: 0.25 [0.16-0.38]) in severe COVID-19 patients. The survival rate was more significant in severe patients with diabetes mellitus or hypertension after receiving dexamethasone treatment (HR:0.19). On the other hand, patients without severe disease did not benefit from dexamethasone administration.

1. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. N Engl J Med. 2020.
2. Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al. Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial. Jama. 2020;324(13):1307-16.
3. Bartoli A, Gabrielli F, Alicandro T, Nascimbeni F, Andreone P. COVID-19 treatment options: a difficult journey between failed attempts and experimental drugs. Intern Emerg Med. 2021:1-28.
4. Soleimani A, Kazemian S, Karbalai Saleh S, Aminorroaya A, Shajari Z, Hadadi A, et al. Effects of Angiotensin Receptor Blockers (ARBs) on In-Hospital Outcomes of Patients With Hypertension and Confirmed or Clinically Suspected COVID-19. Am J Hypertens. 2020;33(12):1102-11.
5. Ahmed MH, Hassan A. Dexamethasone for the Treatment of Coronavirus Disease (COVID-19): a Review. SN Compr Clin Med. 2020:1-10.
6. Ranjbar K, Moghadami M, Mirahmadizadeh A, Fallahi MJ, Khaloo V, Shahriarirad R, et al. Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial. BMC Infect Dis. 2021;21(1):337.
7. Lester M, Sahin A, Pasyar A. The use of dexamethasone in the treatment of COVID-19. Annals of Medicine and Surgery. 2020.
8. Johnson RM, Vinetz JM. Dexamethasone in the management of covid -19. Bmj. 2020;370:m2648.
9. Shuto H, Komiya K, Yamasue M, Uchida S, Ogura T, Mukae H, et al. A systematic review of corticosteroid treatment for noncritically ill patients with COVID-19. Sci Rep. 2020;10(1):20935.
10. Pazoki M, Keykhaei M, Kafan S, Montazeri M, Mirabdolhagh Hazaveh M, Sotoodehnia M, et al. Risk indicators associated with in-hospital mortality and severity in patients with diabetes mellitus and confirmed or clinically suspected COVID-19. J Diabetes Metab Disord. 2021:1-11.
11. Sterne JAC, Murthy S, Diaz JV, Slutsky AS, Villar J, Angus DC, et al. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. Jama. 2020;324(13):1330-41.
12. Talebpour M, Hadadi A, Oraii A, Ashraf H. Rationale and Design of a Registry in a Referral and Educational Medical Center in Tehran, Iran: Sina Hospital Covid-19 Registry (SHCo-19R). Advanced Journal of Emergency Medicine. 2020;4(2s):e53-e.
13. Thoemmes F. Propensity score matching in SPSS. arXiv preprint arXiv:12016385. 2012.
14. Li Q, Li W, Jin Y, Xu W, Huang C, Li L, et al. Efficacy Evaluation of Early, Low-Dose, Short-Term Corticosteroids in Adults Hospitalized with Non-Severe COVID-19 Pneumonia: A Retrospective Cohort Study. Infect Dis Ther. 2020;9(4):823-36.
15. Hu Z, Lv Y, Xu C, Sun W, Chen W, Peng Z, et al. Clinical Use of Short-Course and Low-Dose Corticosteroids in Patients With Non-severe COVID-19 During Pneumonia Progression. Front Public Health. 2020;8:355.
Files
IssueVol 60, No 7 (2022) QRcode
SectionArticles
DOI https://doi.org/10.18502/acta.v60i7.10212
Keywords
Coronavirus disease 2019 (COVID-19) Dexamethasone Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Corticosteroid Mortality

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Montazeri M, Pazoki M, Hadadi A, Shafeghat M, Veisizadeh A, Khajavi MR, Najmeddin F, Kafan S. Dexamethasone Treatment in Patients With Severe COVID-19: A Propensity Score-Matched Study. Acta Med Iran. 2022;60(7):413-417.