High- vs Standard-dose Dexamethasone Could Pose Risks for Ventilated COVID-19 Patients

Mortality outcomes for patients hospitalized with COVID-19 and receiving supplemental oxygen were similar with high-dose vs standard-dose dexamethasone, but findings from a new study suggest that higher doses of the corticosteroid may lead to adverse outcomes.

The study was presented at IDWeek 2022, held from October 19 to 23, in Washington, DC.

Dexamethasone and other anti-inflammatory drugs are standard treatment for patients hospitalized with COVID-19. A 6-mg dose of dexamethasone daily has been shown to improve outcomes among patients with the SARS-CoV-2 infection who are receiving supplemental oxygen. According to the study authors, however, higher doses are often prescribed despite the absence of evidence to support the treatment intensification.

The researchers were interested in outcomes with higher doses of dexamethasone, specifically whether they might be more effective vs the standard. They conducted a multisite, retrospective, observational study that included patients hospitalized with COVID-19 infection and receiving supplemental oxygen between June 2020 and January 2022.

Patients who received high-dose dexamethasone (>10 mg daily; n=159) were matched 3:1 with those who received standard-dose dexamethasone (6 mg daily; n=53); outcomes between the groups were compared.

No significant differences were observed on the basis of high vs standard dexamethasone dosing in mortality rate, the number of patients with elevated blood glucose dexamethason concentrations (>200 mg/dL), the rate of nosocomial infections, or the number of ventilator-free days (all p>.05), according to the abstract.

Nor were there any significant differences in mortality risk observed between the high- and standard-dose groups after investigators adjusted for potential confounding variables (adjusted odds ratio [aOR], 1.45; 95% CI, 0.66-3.20).

The authors did report, however, that in the adjusted analysis, receiving high-dose dexamethasone was associated with increases in daily blood glucose concentrations (P =.003) and length of intensive care unit stay (P =.019) compared with receipt of standard-dose dexamethasone.

The researchers conclude that their findings support the use of standard-dose dexamethasone in COVID-19 patients on ventilation.

Reference: Kale-Pradhan P, Pacitto R, Krumm L, et al. Effect of high-dose versus standard-dose dexamethasone on mortality among mechanically ventilated COVID-19 patients. Poster presented at: IDWeek 2022; October 19-23; Washington, DC.