Target Groups for a Short Dexamethasone Course among Critically Ill COVID-19 Patients
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...
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Wiley
2021-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2021/5557302 |
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| author | Armen Oganesyan Ruslan Menzulin Yury Surovoy Andrei Nikiforchin Kirill Zykov |
| author_facet | Armen Oganesyan Ruslan Menzulin Yury Surovoy Andrei Nikiforchin Kirill Zykov |
| author_sort | Armen Oganesyan |
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| description | 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 |
| format | Article |
| id | doaj-art-7c68b2d7a26a4ddc8f0efa0ed1b5f527 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
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| series | Critical Care Research and Practice |
| spelling | doaj-art-7c68b2d7a26a4ddc8f0efa0ed1b5f5272025-02-03T05:47:09ZengWileyCritical Care Research and Practice2090-13052090-13132021-01-01202110.1155/2021/55573025557302Target Groups for a Short Dexamethasone Course among Critically Ill COVID-19 PatientsArmen Oganesyan0Ruslan Menzulin1Yury Surovoy2Andrei Nikiforchin3Kirill Zykov4Clinical Hospital #1 MEDSI, Intensive Care Unit, 1 Pyatnitskoe Shosse 6th km, Otradnoe, Krasnogorsky Rayon, Moscow Oblast 143442, RussiaClinical Hospital #1 MEDSI, Intensive Care Unit, 1 Pyatnitskoe Shosse 6th km, Otradnoe, Krasnogorsky Rayon, Moscow Oblast 143442, RussiaClinical Hospital #1 MEDSI, Intensive Care Unit, 1 Pyatnitskoe Shosse 6th km, Otradnoe, Krasnogorsky Rayon, Moscow Oblast 143442, RussiaThe Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, Weinberg Building, Baltimore 21202, MD, USAPulmonology Research Institute, Federal Medical and Biology Agency of Russia, 28 Orekhovyy Bul’var, Moscow 115682, RussiaIntroduction. 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 patientshttp://dx.doi.org/10.1155/2021/5557302 |
| spellingShingle | Armen Oganesyan Ruslan Menzulin Yury Surovoy Andrei Nikiforchin Kirill Zykov Target Groups for a Short Dexamethasone Course among Critically Ill COVID-19 Patients Critical Care Research and Practice |
| title | Target Groups for a Short Dexamethasone Course among Critically Ill COVID-19 Patients |
| title_full | Target Groups for a Short Dexamethasone Course among Critically Ill COVID-19 Patients |
| title_fullStr | Target Groups for a Short Dexamethasone Course among Critically Ill COVID-19 Patients |
| title_full_unstemmed | Target Groups for a Short Dexamethasone Course among Critically Ill COVID-19 Patients |
| title_short | Target Groups for a Short Dexamethasone Course among Critically Ill COVID-19 Patients |
| title_sort | target groups for a short dexamethasone course among critically ill covid 19 patients |
| url | http://dx.doi.org/10.1155/2021/5557302 |
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