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

被引：21

作者：

Hoertel, Nicolas ^{[1
,2
,3
]}

Sanchez-Rico, Marina ^{[1
,4
]}

Vernet, Raphael ^{[5
]}

Beeker, Nathanael ^{[6
]}

Neuraz, Antoine ^{[7
,8
]}

Alvarado, Jesus M. ^{[4
]}

Daniel, Christel ^{[9
,10
]}

Paris, Nicolas ^{[9
,11
]}

Gramfort, Alexandre ^{[12
]}

Lemaitre, Guillaume ^{[12
]}

Salamanca, Elisa ^{[13
]}

Bernaux, Melodie ^{[14
]}

Bellamine, Ali ^{[15
]}

Burgun, Anita ^{[7
]}

Limosin, Frederic ^{[1
,2
,3
]}

机构：

[1] Hop Corentin Celton, AP HP Ctr, Dept Psychiat, Issy Les Moulineaux, France

[2] Univ Paris, INSERM, Inst Psychiat & Neurosci Paris, Paris, France

[3] Univ Paris, Fac Sante, UFR Med, Paris, France

[4] Univ Complutense Madrid, Fac Psychol, Dept Psychobiol & Behav Sci Methods, Campus Somosaguas, Pozuelo De Alarcon, Spain

[5] Univ Paris, Hop Europeen Georges Pompidou, AP HP Ctr, Med Informat Biostat & Publ Hlth Dept, Paris, France

[6] Hop Cochin, AP HP, Unite Rech Clin, Paris, France

[7] Univ Paris, Cordeliers Res Ctr, INSERM, UMR S 1138, Paris, France

[8] Univ Paris, Necker Enfants Malad Hosp, AP HP Ctr, Dept Med Informat, Paris, France

[9] AP HP, DSI WIND Web Innovat Donnees, Paris, France

[10] Sorbonne Univ, Univ Paris 13, Sorbonne Paris Cite, INSERM UMR S 1142, Paris, France

[11] Univ Paris Saclay, Univ Paris Sud, CNRS, LIMSI, Orsay, France

[12] Univ Paris Saclay, CEA, INRIA, Palaiseau, France

[13] Banque Natl Donnees Malad Rares BNDMR, Dept WIND Web Innovat Donnees, Campus Picpus, Paris, France

[14] AP HP, Direct Strategie & Transformat, Paris, France

[15] Univ Paris, Hop Cochin, AP HP Ctr, Unite Rech Clin, Paris, France

来源：

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY | 2021年 / 87卷 / 10期

关键词：

COVID-19; dexamethasone; efficacy; mortality; oxygen; SARS-CoV-2; treatment; ventilation;

D O I：

10.1111/bcp.14784

中图分类号：

R9 [药学];

学科分类号：

1007 ;

摘要：

Aims 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 reverse transcriptase-polymerase chain reaction 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 298/1129 (26.4%) patients who did not. In this group, there was a significant association between dexamethasone use and reduced mortality in the primary analysis (hazard ratio, 0.46; 95% confidence interval 0.22-0.96, P = .039). Among patients who did not require respiratory support, there was no significant association between dexamethasone use and the endpoint. Conclusions In this multicentre observational study, dexamethasone use administered either orally or by intravenous injection at a cumulative dose between 60 mg and 150 mg was associated with reduced mortality among patients with COVID-19 requiring respiratory support.

引用

页码：3766 / 3775

页数：10

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