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High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study

Low-dose dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). We retrospectively analyzed the efficacy of high-dose dexamethasone in patients with COVID-19-related ARDS and evaluated factors affecting the composite o...

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Autores principales: Vecchié, Alessandra, Batticciotto, Alberto, Tangianu, Flavio, Bonaventura, Aldo, Pennella, Benedetta, Abenante, Alessia, Corso, Rossana, Grazioli, Stefano, Mumoli, Nicola, Para, Ombretta, Maresca, Andrea Maria, Dalla Gasperina, Daniela, Dentali, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286167/
https://www.ncbi.nlm.nih.gov/pubmed/34275096
http://dx.doi.org/10.1007/s11739-021-02800-1
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author Vecchié, Alessandra
Batticciotto, Alberto
Tangianu, Flavio
Bonaventura, Aldo
Pennella, Benedetta
Abenante, Alessia
Corso, Rossana
Grazioli, Stefano
Mumoli, Nicola
Para, Ombretta
Maresca, Andrea Maria
Dalla Gasperina, Daniela
Dentali, Francesco
author_facet Vecchié, Alessandra
Batticciotto, Alberto
Tangianu, Flavio
Bonaventura, Aldo
Pennella, Benedetta
Abenante, Alessia
Corso, Rossana
Grazioli, Stefano
Mumoli, Nicola
Para, Ombretta
Maresca, Andrea Maria
Dalla Gasperina, Daniela
Dentali, Francesco
author_sort Vecchié, Alessandra
collection PubMed
description Low-dose dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). We retrospectively analyzed the efficacy of high-dose dexamethasone in patients with COVID-19-related ARDS and evaluated factors affecting the composite outcome (death or invasive mechanical ventilation). From March 4th to April 1st 2020, 98 patients with COVID-19 pneumonia were included. Those who after at least 7 days from symptom onset presented a worsening of the respiratory function or of inflammatory biomarkers were started on intravenous high-dose dexamethasone (20 mg daily for 5 days, followed by 10 mg daily for 5 days). Most patients were males (62%) with a mean age of 69 years. Hypertension and cardiovascular disease (CVD) were prevalent. Following dexamethasone treatment, a significant improvement in PaO(2)/FiO(2) (277.41 [178.5–374.8] mmHg vs. 146.75 [93.62–231.16] mmHg, p < 0.001), PaO(2) (88.15 [76.62–112.0] mmHg vs. 65.65 [57.07–81.22] mmHg, p < 0.001), and SpO(2) (96 [95–98]% vs. 94 [90–96]%, p < 0.001) was observed. A concomitant decrease in C-reactive protein and ferritin levels was found (132.25 [82.27–186.5] mg/L vs. 7.3 [3.3–24.2] mg/L and 1169 [665–2056] ng/mL vs. 874.0 [569.5–1434] ng/mL, respectively; p < 0.001 for both vs. baseline). CVD was found to increase the risk of the composite outcome (RR 7.64, 95% CI 1.24–47.06, p = 0.028). In hospitalized patients with COVID-19-related ARDS, high-dose dexamethasone rapidly improves the clinical status and decreases inflammatory biomarkers. CVD was found to increase the risk of the composite outcome. These data support the importance of randomized clinical trials with high-dose dexamethasone in COVID-19 patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-021-02800-1.
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spelling pubmed-82861672021-07-19 High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study Vecchié, Alessandra Batticciotto, Alberto Tangianu, Flavio Bonaventura, Aldo Pennella, Benedetta Abenante, Alessia Corso, Rossana Grazioli, Stefano Mumoli, Nicola Para, Ombretta Maresca, Andrea Maria Dalla Gasperina, Daniela Dentali, Francesco Intern Emerg Med Im - Original Low-dose dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). We retrospectively analyzed the efficacy of high-dose dexamethasone in patients with COVID-19-related ARDS and evaluated factors affecting the composite outcome (death or invasive mechanical ventilation). From March 4th to April 1st 2020, 98 patients with COVID-19 pneumonia were included. Those who after at least 7 days from symptom onset presented a worsening of the respiratory function or of inflammatory biomarkers were started on intravenous high-dose dexamethasone (20 mg daily for 5 days, followed by 10 mg daily for 5 days). Most patients were males (62%) with a mean age of 69 years. Hypertension and cardiovascular disease (CVD) were prevalent. Following dexamethasone treatment, a significant improvement in PaO(2)/FiO(2) (277.41 [178.5–374.8] mmHg vs. 146.75 [93.62–231.16] mmHg, p < 0.001), PaO(2) (88.15 [76.62–112.0] mmHg vs. 65.65 [57.07–81.22] mmHg, p < 0.001), and SpO(2) (96 [95–98]% vs. 94 [90–96]%, p < 0.001) was observed. A concomitant decrease in C-reactive protein and ferritin levels was found (132.25 [82.27–186.5] mg/L vs. 7.3 [3.3–24.2] mg/L and 1169 [665–2056] ng/mL vs. 874.0 [569.5–1434] ng/mL, respectively; p < 0.001 for both vs. baseline). CVD was found to increase the risk of the composite outcome (RR 7.64, 95% CI 1.24–47.06, p = 0.028). In hospitalized patients with COVID-19-related ARDS, high-dose dexamethasone rapidly improves the clinical status and decreases inflammatory biomarkers. CVD was found to increase the risk of the composite outcome. These data support the importance of randomized clinical trials with high-dose dexamethasone in COVID-19 patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-021-02800-1. Springer International Publishing 2021-07-17 2021 /pmc/articles/PMC8286167/ /pubmed/34275096 http://dx.doi.org/10.1007/s11739-021-02800-1 Text en © Società Italiana di Medicina Interna (SIMI) 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Im - Original
Vecchié, Alessandra
Batticciotto, Alberto
Tangianu, Flavio
Bonaventura, Aldo
Pennella, Benedetta
Abenante, Alessia
Corso, Rossana
Grazioli, Stefano
Mumoli, Nicola
Para, Ombretta
Maresca, Andrea Maria
Dalla Gasperina, Daniela
Dentali, Francesco
High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study
title High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study
title_full High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study
title_fullStr High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study
title_full_unstemmed High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study
title_short High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study
title_sort high-dose dexamethasone treatment for covid-19 severe acute respiratory distress syndrome: a retrospective study
topic Im - Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286167/
https://www.ncbi.nlm.nih.gov/pubmed/34275096
http://dx.doi.org/10.1007/s11739-021-02800-1
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