Dexamethasone use and mortality in hospitalized patients with coronavirus disease 2019: A multicentre retrospective observational study

Abstract

Aim: To examine the association between dexamethasone use and mortality among patients hospitalized for COVID-19. Methods: We examined the association between dexamethasone use and mortality at AP-HP Greater Paris University hospitals. Study baseline was defined as the date of hospital admission. The primary endpoint was time to death. We compared this endpoint between patients who received dexamethasone and those who did not in time-to-event analyses adjusted for patient characteristics (such as age, sex, and comorbidity) and clinical and biological markers of clinical severity of COVID-19, and stratified by the need for respiratory support, i.e. mechanical ventilation or oxygen. The primary analysis was a multivariable Cox regression model. Results: Of 12,217 adult patients hospitalized with a positive COVID-19 PT-PCR test, 171 (1.4%) received dexamethasone orally or by intravenous perfusion during the visit. Among patients who required respiratory support, the end-point occurred in 10/63 (15.9%) patients who received dexamethasone and 298/1,129 (26.4%) patients who did not. In this group, there was a significant association between dexamethasone use and reduced mortality in the primary analysis (HR, 0.46; 95%CI, 0.22 to 0.96, p=0.039). Among patients who did not require respiratory support, there was no significant association between dexamethasone use and the endpoint. Conclusions: In this multicenter observational study, dexamethasone use administered either orally or by intravenous injection at a cumulative dose between 60 mg and 150 mg was This article is protected by copyright. All rights reserved. associated with reduced mortality among patients with COVID-19 requiring respiratory support.

The acid sphingomyelinase/ceramide system in COVID-19

“… Currently, hyperinflammation in COVID-19 is treated with broad-spectrum corticosteroids or specific monoclonal antibodies. While corticosteroids have a substantial effect among critically ill patients with COVID-19 [ 106 , 107 ], the effect of specific therapies, for example, tocilizumab as a monoclonal humanized antibody against IL-6, appears to be significantly smaller [ 108 ]. ASM is a critical regulator of IL-6 production [ 109 ] and plays an important role in TNF-alpha signaling [ 110 ].…”

Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID‐19: An Observational Multicenter Study

“…A multicenter cohort study was conducted at 36 Assistance Publique-Hôpitaux de Paris (AP-HP) hospitals from the beginning of the epidemic in France (i.e., January 24 until May 1, 2020). 14,15,19,20,21 We included all adults aged 18 years or over who have been hospitalized in these medical centers for severe COVID-19. COVID-19 was ascertained by a positive reverse-transcriptase-polymerase-chain-reaction (RT-PCR) test on nasopharyngeal or oropharyngeal swab specimens.…”

Hydroxyzine Use and Mortality in Patients Hospitalized for COVID-19: A Multicenter Observational Study

“…A multicenter cohort study was conducted at 36 AP-HP hospitals from the beginning of the epidemic in France, i.e., 24 January until 1 May 2020 [23,[42][43][44][45]. We included all adults aged 18 years or over who had been hospitalized in these medical centers for COVID-19.…”

“…To this end, we used data from the Assistance Publique-Hôpitaux de Paris (AP-HP) Health Data Warehouse [23,[42][43][44][45], which includes data on all patients who have been admitted for COVID-19 to any of 36 Greater Paris University hospitals.…”