Skip to main content

Dexamethasone for Inpatients With COVID-19 in a National Cohort.

Publication ,  Journal Article
Mourad, A; Thibault, D; Holland, TL; Yang, S; Young, AR; Arnold Egloff, SA; Thomas, LE
Published in: JAMA Netw Open
April 3, 2023

IMPORTANCE: 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. OBJECTIVE: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. EXPOSURES: Systemic dexamethasone administered within 48 hours of either admission or escalation in oxygen support. MAIN OUTCOMES AND MEASURES: All-cause in-hospital mortality or discharge to hospice. RESULTS: 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. CONCLUSIONS AND RELEVANCE: 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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

April 3, 2023

Volume

6

Issue

4

Start / End Page

e238516

Location

United States

Related Subject Headings

  • SARS-CoV-2
  • Retrospective Studies
  • Middle Aged
  • Inpatients
  • Humans
  • Female
  • Dexamethasone
  • Cohort Studies
  • COVID-19 Drug Treatment
  • COVID-19
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Mourad, A., Thibault, D., Holland, T. L., Yang, S., Young, A. R., Arnold Egloff, S. A., & Thomas, L. E. (2023). Dexamethasone for Inpatients With COVID-19 in a National Cohort. JAMA Netw Open, 6(4), e238516. https://doi.org/10.1001/jamanetworkopen.2023.8516
Mourad, Ahmad, Dylan Thibault, Thomas L. Holland, Siyun Yang, Allison R. Young, Shanna A. Arnold Egloff, and Laine E. Thomas. “Dexamethasone for Inpatients With COVID-19 in a National Cohort.JAMA Netw Open 6, no. 4 (April 3, 2023): e238516. https://doi.org/10.1001/jamanetworkopen.2023.8516.
Mourad A, Thibault D, Holland TL, Yang S, Young AR, Arnold Egloff SA, et al. Dexamethasone for Inpatients With COVID-19 in a National Cohort. JAMA Netw Open. 2023 Apr 3;6(4):e238516.
Mourad, Ahmad, et al. “Dexamethasone for Inpatients With COVID-19 in a National Cohort.JAMA Netw Open, vol. 6, no. 4, Apr. 2023, p. e238516. Pubmed, doi:10.1001/jamanetworkopen.2023.8516.
Mourad A, Thibault D, Holland TL, Yang S, Young AR, Arnold Egloff SA, Thomas LE. Dexamethasone for Inpatients With COVID-19 in a National Cohort. JAMA Netw Open. 2023 Apr 3;6(4):e238516.

Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

April 3, 2023

Volume

6

Issue

4

Start / End Page

e238516

Location

United States

Related Subject Headings

  • SARS-CoV-2
  • Retrospective Studies
  • Middle Aged
  • Inpatients
  • Humans
  • Female
  • Dexamethasone
  • Cohort Studies
  • COVID-19 Drug Treatment
  • COVID-19