Dexamethasone use and Mortality in Hospitalized Patients with Coronavirus Disease 2019: a Multicenter Retrospective Observational Study

https://www.medrxiv.org/content/10.1101/2020.10.23.20218172v1

Among patients who required respiratory support, the end-point event of death occurred in 10 patients (15.9%) who received dexamethasone and 298 patients (26.4%) who did not. In this group of patients, there was a significant association between dexamethasone use and reduced mortality in both the crude, unadjusted analysis (hazard ratio (HR), 0.40; 95% CI, 0.18 to 0.87, p=0.021) and the adjusted multivariable analysis (HR, 0.46; 95% CI, 0.22 to 0.96, p=0.039). In the sensitivity analysis, the univariate Cox regression model in the matched analytic sample yielded a same tendency, albeit non-significant (HR, 0.31; 95% CI, 0.08 to 1.14, p=0.077). Among patients without respiratory support, the end-point event of death occurred in 14 patients (13.0%) who received dexamethasone and 1,086 patients (10.0%) who did not. In this group of patients, there was no significant association between dexamethasone use and the endpoint. When examining the association between the cumulative dose of dexamethasone received during the visit and the endpoint, we found that the administration of a cumulative dose between 60 mg to 150 mg among patients who required respiratory support was significantly associated with a lower risk of death in the crude, unadjusted analysis (HR, 0.28; SE, 0.58, p=0.028), the adjusted multivariable analysis (HR, 0.24; SE, 0.65, p=0.030), and in the univariate Cox regression model in the matched analytic sample (HR, 0.32; SE, 0.58, p=0.048), whereas no significant association was observed with a different dose. Among patients without respiratory support, there was no significant association between the cumulative dose of dexamethasone and the endpoint in the crude and in the adjusted multivariable analyses. In this observational study involving patients with Covid-19 who had been admitted to the hospital, dexamethasone use administered either orally or by intravenous injection at a cumulative dose between 60 mg and 150 mg was associated with decreased mortality among those requiring respiratory support.

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