tetano
Editor, Senior Moderator
Respir Investig
. 2023 Sep 14;61(6):760-767.
doi: 10.1016/j.resinv.2023.07.001. Online ahead of print. Limited efficacy of low-dose dexamethasone for the treatment of severe COVID-19 pneumonia: A retrospective study
Satoshi Inoue[SUP] 1 [/SUP], Yuki Kata[SUP] 2 [/SUP], Yoshihiro Suido[SUP] 2 [/SUP], Kentaro Nakashima[SUP] 2 [/SUP], Yukiko Otsu[SUP] 2 [/SUP], Hirokazu Takayasu[SUP] 2 [/SUP], Yutaka Matsumoto[SUP] 2 [/SUP], Takeshi Kaneko[SUP] 3 [/SUP]
Affiliations
Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Its symptoms range from mild to severe, with the latter often being life-threatening. This study aims to assess the effects of low-dose dexamethasone (DEX) in mild-to-severe COVID-19 pneumonia and examine the final clinical outcomes to identify the optimal therapeutic dose.
Methods: Clinical data from 132 patients hospitalized for COVID-19 pneumonia between January and October 2021 at Yamato Municipal Hospital were retrospectively analyzed. Based on the ratio of peripheral arterial oxygen saturation (SpO[SUB]2[/SUB]) to inspired fraction of oxygen (FiO[SUB]2[/SUB]), patients were categorized into the mild (>450, n = 65), moderate (315-450, n = 55), and severe (<315, n = 12) pneumonia groups. The event of interest was defined as the worsening of the patient's condition during treatment (need to increase FiO[SUB]2[/SUB] > 0.1). Patients were treated with low-dose DEX (6.6 mg/day) for 10 days.
Results: The event-free survival rate decreased significantly in patients with severe pneumonia compared with in those with mild and moderate pneumonia (Bonferroni-adjusted p < 0.02). A total of 16 patients were treated with high-dose corticosteroids because of severe hypoxia. Recovery was observed in all discharged patients with respiratory condition improvement. Low SpO[SUB]2[/SUB]/FiO[SUB]2[/SUB] at admission was significantly associated with serum C-reactive protein levels.
Conclusions: For Japanese patients with COVID-19, severe pneumonia, and SpO[SUB]2[/SUB]/FiO[SUB]2[/SUB] of <315, it may be necessary to administer a dose of corticosteroids of >6.6 mg DEX.
Keywords: Adaptive dose-finding study; Low-dose dexamethasone; SARS-CoV-2; Severe COVID-19 pneumonia.
. 2023 Sep 14;61(6):760-767.
doi: 10.1016/j.resinv.2023.07.001. Online ahead of print. Limited efficacy of low-dose dexamethasone for the treatment of severe COVID-19 pneumonia: A retrospective study
Satoshi Inoue[SUP] 1 [/SUP], Yuki Kata[SUP] 2 [/SUP], Yoshihiro Suido[SUP] 2 [/SUP], Kentaro Nakashima[SUP] 2 [/SUP], Yukiko Otsu[SUP] 2 [/SUP], Hirokazu Takayasu[SUP] 2 [/SUP], Yutaka Matsumoto[SUP] 2 [/SUP], Takeshi Kaneko[SUP] 3 [/SUP]
Affiliations
- PMID: 37716284
- DOI: 10.1016/j.resinv.2023.07.001
Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Its symptoms range from mild to severe, with the latter often being life-threatening. This study aims to assess the effects of low-dose dexamethasone (DEX) in mild-to-severe COVID-19 pneumonia and examine the final clinical outcomes to identify the optimal therapeutic dose.
Methods: Clinical data from 132 patients hospitalized for COVID-19 pneumonia between January and October 2021 at Yamato Municipal Hospital were retrospectively analyzed. Based on the ratio of peripheral arterial oxygen saturation (SpO[SUB]2[/SUB]) to inspired fraction of oxygen (FiO[SUB]2[/SUB]), patients were categorized into the mild (>450, n = 65), moderate (315-450, n = 55), and severe (<315, n = 12) pneumonia groups. The event of interest was defined as the worsening of the patient's condition during treatment (need to increase FiO[SUB]2[/SUB] > 0.1). Patients were treated with low-dose DEX (6.6 mg/day) for 10 days.
Results: The event-free survival rate decreased significantly in patients with severe pneumonia compared with in those with mild and moderate pneumonia (Bonferroni-adjusted p < 0.02). A total of 16 patients were treated with high-dose corticosteroids because of severe hypoxia. Recovery was observed in all discharged patients with respiratory condition improvement. Low SpO[SUB]2[/SUB]/FiO[SUB]2[/SUB] at admission was significantly associated with serum C-reactive protein levels.
Conclusions: For Japanese patients with COVID-19, severe pneumonia, and SpO[SUB]2[/SUB]/FiO[SUB]2[/SUB] of <315, it may be necessary to administer a dose of corticosteroids of >6.6 mg DEX.
Keywords: Adaptive dose-finding study; Low-dose dexamethasone; SARS-CoV-2; Severe COVID-19 pneumonia.