Mallory Fiorenza, BCPS, PharmD, BCCCP
Lee Memorial Hospital
Fort Myers, Florida
Disclosure information not submitted.
Jordan Taillon, M.D.
Pulmonologist and Critical Care Specialist
Lee Health, United States
Disclosure information not submitted.
Title: Dexamethasone compared to usual care in patients with COVID-19: Effect on 28-day mortality
Introduction: The novel coronavirus disease 2019 (COVID-19) is a respiratory infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The RECOVERY trial provided evidence that the use of dexamethasone (DEX) reduced 28-day mortality in COVID-19 patients that received respiratory support (required oxygen with or without ventilator support). Similar to the RECOVERY trial, the purpose of this study was to evaluate the effects of DEX in addition to usual care (UC) compared to UC alone in patients with COVID-19 infection on 28-day in-hospital mortality, while assessing local patterns and patient population benefits of DEX.
Methods: This was a retrospective chart review conducted in adults with laboratory confirmed positive COVID-19 results within a community health-system between March 1, 2020 and November 4, 2020. The primary outcome was all-cause 28-day in-hospital mortality. Secondary outcomes included ventilation requirements [non-invasive ventilation, oxygen only, invasive mechanical ventilation (MV)], duration of invasive MV, discharge from hospital within 28 days, and hospital and intensive care unit length of stay (LOS). Outcomes were also assessed in patients that received remdesivir or convalescent plasma in addition to DEX.
Results: A total of 300 patients were included in the analysis and 110 patents were included in the matched cohort. The baseline patient demographics were similar between the two groups, except patients had a higher mean weight in the DEX group (88.8 kg vs. 79.7 kg, p< 0.005). For the unmatched cohort, there was no statistical difference found in 28-day in-hospital mortality. Patients in the DEX group required more non-invasive ventilation (9/100 (9%) vs. 3/200 (1.5%), p< 0.001) and oxygen only support (70/100 (70%) vs. 108/200 (54%), p< 0.001), but less patients in the DEX group did not require any respiratory support (14/100 (14%) vs. 77/200 (39%), p< 0.001). In the matched cohort, the DEX group had a significantly shorter hospital LOS compared to patients in the UC group (9 days vs. 12 days, p=0.048).
Conclusions: This study demonstrated no statistical difference on the 28-day in-hospital mortality between the two groups. However, in the matched cohort the DEX group had a significantly shorter hospital LOS.