Dexamethasone Treatment in Patients With Severe COVID-19: A Propensity Score-Matched Study

Mahnaz Montazeri; Marzieh Pazoki; Azar Hadadi; Melika Shafeghat; Abdolazim Veisizadeh; Mohammad Reza Khajavi; Farhad Najmeddin; Samira Kafan

doi:10.18502/acta.v60i7.10212

Mahnaz Montazeri Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Marzieh Pazoki Department of Pulmonary Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Azar Hadadi Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Melika Shafeghat Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
Abdolazim Veisizadeh Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Reza Khajavi Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Farhad Najmeddin Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
Samira Kafan Department of Pulmonary Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/acta.v60i7.10212

Keywords: Coronavirus disease 2019 (COVID-19); Dexamethasone; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); Corticosteroid; Mortality

Abstract

During the coronavirus disease-2019 (COVID-19) pandemic, which was caused by the novel coronavirus, there is an ongoing controversy about the use of corticosteroids. This study aims to investigate the association between Dexamethasone treatment and clinical outcomes in patients with severe COVID-19. In this single-center retrospective cohort study, patients with COVID-19 were enrolled from February 16, 2020, to November 1, 2020. After performing propensity score matching with age, sex, and disease severity. The independent effect of Dexamethasone treatment on in-hospital mortality was evaluated by multivariate proportional hazards regression models. Of 1413 patients with COVID-19 diagnosis, 1172 patients entered the final analysis. 473(40.4%) patients received dexamethasone treatment with a median duration of 6.0[4.0-9.0] days. After matching and adjustment with possible confounders in the multivariate model, administration of dexamethasone significantly increased the survival in severe patients (hazard ratio: 0.25, 95 confidence intervals: 0.16-0.38, P<0.001), but there was no difference in non-severe patients (P:0.888). The administering of dexamethasone was associated with an increased in-hospital survival rate (HR: 0.25 [0.16-0.38]) in severe COVID-19 patients. The survival rate was more significant in severe patients with diabetes mellitus or hypertension after receiving dexamethasone treatment (HR:0.19). On the other hand, patients without severe disease did not benefit from dexamethasone administration.