tetano
Editor, Senior Moderator
J Microbiol Immunol Infect
. 2024 Feb 17:S1684-1182(24)00039-2.
doi: 10.1016/j.jmii.2024.02.002. Online ahead of print. Effect of early dexamethasone on outcomes of COVID-19: A quasi-experimental study using propensity score matching
Wang-Da Liu[SUP] 1 [/SUP], Jann-Tay Wang[SUP] 2 [/SUP], Ming-Chieh Shih[SUP] 3 [/SUP], Kai-Hsiang Chen[SUP] 4 [/SUP], Szu-Ting Huang[SUP] 5 [/SUP], Chun-Fu Huang[SUP] 6 [/SUP], Tien-Hao Chang[SUP] 7 [/SUP], Ming-Jui Tsai[SUP] 8 [/SUP], Po-Hsien Kuo[SUP] 9 [/SUP], Yi-Chen Yeh[SUP] 10 [/SUP], Wan-Chen Tsai[SUP] 11 [/SUP], Mei-Yan Pan[SUP] 12 [/SUP], Guei-Chi Li[SUP] 13 [/SUP], Yi-Jie Chen[SUP] 14 [/SUP], Kuan-Yin Lin[SUP] 15 [/SUP], Yu-Shan Huang[SUP] 16 [/SUP], Aristine Cheng[SUP] 17 [/SUP], Pao-Yu Chen[SUP] 18 [/SUP], Sung-Ching Pan[SUP] 19 [/SUP], Hsin-Yun Sun[SUP] 20 [/SUP], Shih-Chi Ku[SUP] 21 [/SUP], Sui-Yuan Chang[SUP] 22 [/SUP], Wang-Huei Sheng[SUP] 23 [/SUP], Chi-Tai Fang[SUP] 24 [/SUP], Chien-Ching Hung[SUP] 25 [/SUP], Yee-Chun Chen[SUP] 26 [/SUP], Yi-Lwun Ho[SUP] 27 [/SUP], Ming-Shiang Wu[SUP] 28 [/SUP], Shan-Chwen Chang[SUP] 29 [/SUP]
Affiliations
Background: The RECOVERY trial demonstrated that the use of dexamethasone is associated with a 36% lower 28-day mortality in hospitalized patients with COVID-19 on invasive mechanical ventilation. Nevertheless, the optimal timing to start dexamethasone remains uncertain.
Methods: We conducted a quasi-experimental study at National Taiwan University Hospital (Taipei, Taiwan) using propensity score matching to simulate a randomized controlled trial to receive or not to receive early dexamethasone (6 mg/day) during the first 7 days following the onset of symptoms. Treatment was standard protocol-based, except for the timing to start dexamethasone, which was left to physicians' decision. The primary outcome is 28-day mortality. Secondary outcomes include secondary infection within 60 days and fulfilling the criteria of de-isolation within 20 days.
Results: A total of 377 patients with COVID-19 were enrolled. Early dexamethasone did not decrease 28-day mortality in all patients (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.97-1.10) or in patients who required O2 for severe/critical disease at admission (aOR, 1.05; 95%CI, 0.94-1.18); but is associated with a 24% increase in superinfection in all patients (aOR, 1.24; 95% CI, 1.12-1.37) and a 23% increase in superinfection in patients of O2 for several/critical disease at admission (aOR, 1.23; 95% CI, 1.02-1.47). Moreover, early dexamethasone is associated with a 42% increase in likelihood of delayed clearance of SARS-CoV-2 virus (adjusted hazard ratio, 1.42; 95% CI, 1.01-1.98).
Conclusion: An early start of dexamethasone (within 7 days after the onset of symptoms) could be harmful to hospitalized patients with COVID-19.
Keywords: Coronavirus; Corticosteroid; SARS-CoV-2; Timing; Viral shedding.
. 2024 Feb 17:S1684-1182(24)00039-2.
doi: 10.1016/j.jmii.2024.02.002. Online ahead of print. Effect of early dexamethasone on outcomes of COVID-19: A quasi-experimental study using propensity score matching
Wang-Da Liu[SUP] 1 [/SUP], Jann-Tay Wang[SUP] 2 [/SUP], Ming-Chieh Shih[SUP] 3 [/SUP], Kai-Hsiang Chen[SUP] 4 [/SUP], Szu-Ting Huang[SUP] 5 [/SUP], Chun-Fu Huang[SUP] 6 [/SUP], Tien-Hao Chang[SUP] 7 [/SUP], Ming-Jui Tsai[SUP] 8 [/SUP], Po-Hsien Kuo[SUP] 9 [/SUP], Yi-Chen Yeh[SUP] 10 [/SUP], Wan-Chen Tsai[SUP] 11 [/SUP], Mei-Yan Pan[SUP] 12 [/SUP], Guei-Chi Li[SUP] 13 [/SUP], Yi-Jie Chen[SUP] 14 [/SUP], Kuan-Yin Lin[SUP] 15 [/SUP], Yu-Shan Huang[SUP] 16 [/SUP], Aristine Cheng[SUP] 17 [/SUP], Pao-Yu Chen[SUP] 18 [/SUP], Sung-Ching Pan[SUP] 19 [/SUP], Hsin-Yun Sun[SUP] 20 [/SUP], Shih-Chi Ku[SUP] 21 [/SUP], Sui-Yuan Chang[SUP] 22 [/SUP], Wang-Huei Sheng[SUP] 23 [/SUP], Chi-Tai Fang[SUP] 24 [/SUP], Chien-Ching Hung[SUP] 25 [/SUP], Yee-Chun Chen[SUP] 26 [/SUP], Yi-Lwun Ho[SUP] 27 [/SUP], Ming-Shiang Wu[SUP] 28 [/SUP], Shan-Chwen Chang[SUP] 29 [/SUP]
Affiliations
- PMID: 38402071
- DOI: 10.1016/j.jmii.2024.02.002
Background: The RECOVERY trial demonstrated that the use of dexamethasone is associated with a 36% lower 28-day mortality in hospitalized patients with COVID-19 on invasive mechanical ventilation. Nevertheless, the optimal timing to start dexamethasone remains uncertain.
Methods: We conducted a quasi-experimental study at National Taiwan University Hospital (Taipei, Taiwan) using propensity score matching to simulate a randomized controlled trial to receive or not to receive early dexamethasone (6 mg/day) during the first 7 days following the onset of symptoms. Treatment was standard protocol-based, except for the timing to start dexamethasone, which was left to physicians' decision. The primary outcome is 28-day mortality. Secondary outcomes include secondary infection within 60 days and fulfilling the criteria of de-isolation within 20 days.
Results: A total of 377 patients with COVID-19 were enrolled. Early dexamethasone did not decrease 28-day mortality in all patients (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.97-1.10) or in patients who required O2 for severe/critical disease at admission (aOR, 1.05; 95%CI, 0.94-1.18); but is associated with a 24% increase in superinfection in all patients (aOR, 1.24; 95% CI, 1.12-1.37) and a 23% increase in superinfection in patients of O2 for several/critical disease at admission (aOR, 1.23; 95% CI, 1.02-1.47). Moreover, early dexamethasone is associated with a 42% increase in likelihood of delayed clearance of SARS-CoV-2 virus (adjusted hazard ratio, 1.42; 95% CI, 1.01-1.98).
Conclusion: An early start of dexamethasone (within 7 days after the onset of symptoms) could be harmful to hospitalized patients with COVID-19.
Keywords: Coronavirus; Corticosteroid; SARS-CoV-2; Timing; Viral shedding.