Association between early dexamethasone administration and mortality in SARS-CoV-2 infection: A cohort study.

BACKGROUND

Dexamethasone, or equivalent corticosteroids, are recommended for patients with SARS-CoV-2 pneumonia, regardless of respiratory failure status. However, the effects of giving dexamethasone within the first seven days after symptom onset-during the viremic phase-have not been sufficiently studied in clinical trials or observational studies. As a result, the best timing for starting corticosteroids remains uncertain. This study aimed to evaluate the effect of dexamethasone administration within seven days of symptom onset from SARS-CoV-2 infection on mortality and the need for invasive mechanical ventilation among hospitalized patients with severe pneumonia.

METHODS

This cohort study included hospitalized patients aged 18 years or older with severe SARS-CoV-2 pneumonia. The exposure was dexamethasone use before hospitalization, and the outcome measures included in-hospital mortality and invasive mechanical ventilation. Patients were monitored until discharge or death in the hospital. Logistic regression was used to evaluate the association between pre-hospitalization dexamethasone administration and mortality.

RESULTS

We enrolled 234 patients. The median age was 56 years, and 70.5 % were men. Before hospitalization, dexamethasone was administered to 125 (53 %) patients within the first seven days of symptom onset, which was linked to mortality (OR [95 % CI] 3.58 [1.51-8.48]) and the need for invasive mechanical ventilation (OR [95 % CI] 2.59 [1.46-4.59]), after adjusting for factors such as, sex, Charlson comorbidity index ≥ 3, neutrophil count over 8500 cells/mm^3, and albumin below 3 g/dL.

CONCLUSION

Administering dexamethasone within the first seven days of SARS-CoV-2 infection may be associated with a higher risk of death in hospitalized patients with severe pneumonia. These findings emphasize the importance of carefully timing corticosteroid treatment in COVID-19 patients.