Dexamethasone for Inpatients With COVID-19 in a National Cohort

DOI record: { "DOI": "10.1001/jamanetworkopen.2023.8516", "ISSN": [ "2574-3805" ], "URL": "http://dx.doi.org/10.1001/jamanetworkopen.2023.8516", "abstract": "<jats:sec id=\"ab-zoi230272-4\"><jats:title>Importance</jats:title><jats:p>Limited effective therapeutics are available to hospitalized patients with COVID-19. Clinical trials and observational studies have shown varying effects of systemic corticosteroids, including dexamethasone, in hospitalized patients with COVID-19, with limited descriptions of important patient subgroups.</jats:p></jats:sec><jats:sec id=\"ab-zoi230272-5\"><jats:title>Objective</jats:title><jats:p>To examine the clinical use of dexamethasone for hospitalized patients with COVID-19 respiratory illness and to explore the heterogeneity of treatment outcomes across different subgroups.</jats:p></jats:sec><jats:sec id=\"ab-zoi230272-6\"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This is a retrospective, propensity score–weighted cohort study of adult patients hospitalized for at least 48 hours for COVID-19 respiratory illness between July 1, 2020, and October 31, 2021, at a large health care network of 156 hospitals across the US. Data analysis was performed from March 2022 to February 2023.</jats:p></jats:sec><jats:sec id=\"ab-zoi230272-7\"><jats:title>Exposures</jats:title><jats:p>Systemic dexamethasone administered within 48 hours of either admission or escalation in oxygen support.</jats:p></jats:sec><jats:sec id=\"ab-zoi230272-8\"><jats:title>Main Outcomes and Measures</jats:title><jats:p>All-cause in-hospital mortality or discharge to hospice.</jats:p></jats:sec><jats:sec id=\"ab-zoi230272-9\"><jats:title>Results</jats:title><jats:p>A total of 80 699 patients who met the eligibility criteria were identified (median [IQR] age, 64 [52-76] years; 37 606 women [46.6%]); 13 230 patients (16.4%) identified as Black, 49 222 (60.9%) as White, 18 247 (22.6%) as other race, and 20 340 (25.2%) as Hispanic ethnicity. Of these patients, 13 040 (16.2%) did not require supplemental oxygen within 48 hours of admission, 56 368 (69.8%) required supplemental oxygen, 7618 (9.4%) required noninvasive positive pressure ventilation (NIPPV), and 3673 (4.6%) required mechanical ventilation (MV) and/or extracorporeal membrane oxygenation (ECMO). After adjustment by propensity score overlap weighting, early use of dexamethasone was associated with reduction in a composite outcome of in-hospital mortality or discharge to hospice for patients receiving supplemental oxygen (aOR, 0.92; 95% CI, 0.86-0.98) and MV and/or ECMO (aOR, 0.82; 95% CI, 0.68-0.99). In contrast, all-cause inpatient mortality or discharge to hospice was not lower for patients who received dexamethasone in the no supplemental oxygen group (aOR, 0.90; 95% CI, 0.78-1.03) and in the NIPPV group (aOR, 0.87; 95% CI, 0.73-1.04). Importantly, patients with more comorbidities had greater benefit from dexamethasone use.</jats:p></jats:sec><jats:sec id=\"ab-zoi230272-10\"><jats:title>Conclusions and Relevance</jats:title><jats:p>In this national multicenter cohort study of inpatients with COVID-19, early administration of dexamethasone was associated with significantly reduced odds of mortality or discharge to hospice in those requiring supplemental oxygen or MV and/or ECMO but not in those requiring no supplemental oxygen or NIPPV. These results support the continued use of systemic dexamethasone in patients hospitalized with COVID-19.</jats:p></jats:sec>", "author": [ { "affiliation": [ { "name": "Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina" } ], "family": "Mourad", "given": "Ahmad", "sequence": "first" }, { "affiliation": [ { "name": "Duke Clinical Research Institute, Durham, North Carolina" } ], "family": "Thibault", "given": "Dylan", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina" }, { "name": "Duke Clinical Research Institute, Durham, North Carolina" } ], "family": "Holland", "given": "Thomas L.", "sequence": "additional" }, { "affiliation": [ { "name": "Meta Platforms, Inc, Seattle, Washington" } ], "family": "Yang", "given": "Siyun", "sequence": "additional" }, { "affiliation": [ { "name": "Biobot Analytics, Cambridge, Massachusetts" } ], "family": "Young", "given": "Allison R.", "sequence": "additional" }, { "affiliation": [ { "name": "HCA Healthcare Research Institute, Brentwood, Tennessee" } ], "family": "Arnold Egloff", "given": "Shanna A.", "sequence": "additional" }, { "affiliation": [ { "name": "Duke Clinical Research Institute, Durham, North Carolina" }, { "name": "Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina" } ], "family": "Thomas", "given": "Laine E.", "sequence": "additional" } ], "container-title": "JAMA Network Open", "container-title-short": "JAMA Netw Open", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2023, 4, 17 ] ], "date-time": "2023-04-17T15:02:16Z", "timestamp": 1681743736000 }, "deposited": { "date-parts": [ [ 2023, 4, 17 ] ], "date-time": "2023-04-17T15:02:22Z", "timestamp": 1681743742000 }, "indexed": { "date-parts": [ [ 2025, 6, 4 ] ], "date-time": "2025-06-04T18:28:53Z", 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