Target Groups for a Short Dexamethasone Course among Critically Ill COVID-19 Patients

Oganesyan, Armen Menzulin Ruslan Surovoy Yury Nikiforchin Andrei Zykov Kirill

Introduction. Corticosteroids are one of the most promising therapeutic agents for critically ill patients with coronavirus disease 2019 (COVID-19). Despite emerging data, assessed populations and regimens vary, and there are patient subgroups whose response to steroids remains unclear. We aimed to evaluate the outcomes of COVID-19 patients admitted to the intensive care unit (ICU) and treated with a short dexamethasone course to determine which patient categories derive the highest benefit. Methods. A retrospective cohort study was conducted using a prospectively collected single-center ICU database (April 1–October 1, 2020). Adult COVID-19 patients were assigned to dexamethasone (12 mg × 3 days) and usual care groups. Patient, management, and outcome data were extracted. The primary outcome was the 28-day ICU mortality. Subgroup analysis was performed to assess the impact of dexamethasone on mortality in patients with invasive mechanical ventilation (IMV). Results. Of 233 patients, 220 (median age: 65 years, 38% female) were included: 83 patients received dexamethasone and 137 received usual care. Overall, 28 (33.7%) and 54 (39.4%) patients in the dexamethasone and usual care groups, respectively, died within 28 days since ICU admission (rate ratio (RR) 0.86;95% confidence interval (95% CI): 0.59–1.23;p = 0.405). In the IMV cohort, dexamethasone did not decrease the 28-day mortality compared with usual care (47.5% vs. 62.0%;RR 0.78;95% CI: 0.57–1.09;p = 0.107). A subgroup analysis revealed significantly lower 28-day mortality in IMV patients <65 years receiving dexamethasone vs. usual care (22.6% vs. 48.5%;RR 0.47;95% CI: 0.22–0.98;p = 0.043), which was not seen in IMV patients ≥65 years (75.0% vs. 71.1%;RR 1.06;95% CI: 0.79–1.42;p = 0.719). Patients ≥65 years experienced hyperglycemia, bacterial infection, and septic shock significantly more often than younger patients who received dexamethasone (p = 0.002 , p = 0.025 , and p < 0.001 , respectively). Conclusions. A 3-day dexamethasone course is not associated with lower 28-day mortality in critically ill COVID-19 patients, either in the entire ICU cohort or in the IMV. Dexamethasone may significantly reduce the 28-day mortality in IMV patients <65 years, but not in the older IMV subgroup. Dexamethasone administration in patients ≥65 years is associated with a significantly higher rate of adverse events than that in younger patients [ABSTRACT FROM AUTHOR] Copyright of Critical Care Research & Practice is the property of Hindawi Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)