Abstract
Despite the proven benefits of dexamethasone in hospitalized COVID-19 patients, the optimum time for the administration of dexamethasone is unknown. We investigated the progression of COVID-19 pneumonia based on the timing of dexamethasone administration. A single-center, retrospective cohort study based on medical record reviews was conducted between June 10 and September 21, 2020. We compared the risk of severe COVID-19, defined as the use of a high-flow nasal cannula or a mechanical ventilator, between groups that received dexamethasone either within 24 hours of hypoxemia (early dexamethasone group) or 24 hours after hypoxemia (late dexamethasone group). Hypoxemia was defined as room-air SpO2 <90%. Among 59 patients treated with dexamethasone for COVID-19 pneumonia, 30 were in the early dexamethasone group and 29 were in the late dexamethasone group. There was no significant difference in baseline characteristics, the time interval from symptom onset to diagnosis or hospitalization, or the use of antiviral or antibacterial agents between the two groups. The early dexamethasone group showed a significantly lower rate of severe COVID-19 compared to the control group (75.9% vs 40.0%, P-value=0.012). Further, the early dexamethasone group showed a significantly shorter total duration of oxygen supplementation (10.45 d vs. 21.61 d, P-value=0.003) and length of stay in the hospital (19.76 d vs. 27.21 d, P-value=0.013). However, extracorporeal membrane oxygenation and in-hospital mortality rates were not significantly different between the two groups. Early administration of dexamethasone may prevent the progression of COVID-19 to a severe disease, without increased mortality.
Highlights
Systemic administration of corticosteroids has been associated with decreased in-hospital mortality in coronavirus disease 2019 (COVID-19) patients with hypoxemia 1
A recent randomized controlled trials (RCTs) showed that dexamethasone administration within 30 hours of acute respiratory distress syndrome (ARDS) onset decreased the duration of mechanical ventilation and mortality rates 7
Among a total of 212 patients hospitalized for treatment of COVID-19, 62 (29.2%) were treated with dexamethasone
Summary
Systemic administration of corticosteroids has been associated with decreased in-hospital mortality in coronavirus disease 2019 (COVID-19) patients with hypoxemia 1. A recent RCT showed that dexamethasone administration within 30 hours of ARDS onset decreased the duration of mechanical ventilation and mortality rates 7. COVID-19 studies showed a potential benefit of early dexamethasone treatment in improving the prognosis in patients with acute respiratory failure. In the CoDEX trial, dexamethasone administration within 48 hours of the onset of ARDS significantly increased ventilator-free days in the COVID-19 patients 3. A quasi-experimental study of moderate-to-severe COVID-19 cases found that systemic corticosteroid administered from the first day of oxygen supplementation reduced a composite of primary outcomes, including intensive care unit (ICU) care, progression to respiratory failure, and in-hospital mortality 8. We investigated the progression of COVID-19 pneumonia based on the timing of dexamethasone administration
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