High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study

被引：0
作者：
Alessandra Vecchié
Alberto Batticciotto
Flavio Tangianu
Aldo Bonaventura
Benedetta Pennella
Alessia Abenante
Rossana Corso
Stefano Grazioli
Nicola Mumoli
Ombretta Para
Andrea Maria Maresca
Daniela Dalla Gasperina
Francesco Dentali
机构：
[1] ASST Sette Laghi,Department of Internal Medicine
[2] ASST Ovest Milanese,Department of Internal Medicine, Ospedale di Magenta
[3] Azienda Ospedaliero-Universitaria Careggi,SOD Medicina Interna I
[4] Insubria University,Department of Medicine and Surgery
来源：
Internal and Emergency Medicine | 2021年 / 16卷
关键词：
COVID-19; SARS-CoV-2; ARDS; Dexamethasone; Inflammation; PaO; FiO;
D O I：
暂无
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学科分类号：
摘要：
Low-dose dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). We retrospectively analyzed the efficacy of high-dose dexamethasone in patients with COVID-19-related ARDS and evaluated factors affecting the composite outcome (death or invasive mechanical ventilation). From March 4th to April 1st 2020, 98 patients with COVID-19 pneumonia were included. Those who after at least 7 days from symptom onset presented a worsening of the respiratory function or of inflammatory biomarkers were started on intravenous high-dose dexamethasone (20 mg daily for 5 days, followed by 10 mg daily for 5 days). Most patients were males (62%) with a mean age of 69 years. Hypertension and cardiovascular disease (CVD) were prevalent. Following dexamethasone treatment, a significant improvement in PaO2/FiO2 (277.41 [178.5–374.8] mmHg vs. 146.75 [93.62–231.16] mmHg, p < 0.001), PaO2 (88.15 [76.62–112.0] mmHg vs. 65.65 [57.07–81.22] mmHg, p < 0.001), and SpO2 (96 [95–98]% vs. 94 [90–96]%, p < 0.001) was observed. A concomitant decrease in C-reactive protein and ferritin levels was found (132.25 [82.27–186.5] mg/L vs. 7.3 [3.3–24.2] mg/L and 1169 [665–2056] ng/mL vs. 874.0 [569.5–1434] ng/mL, respectively; p < 0.001 for both vs. baseline). CVD was found to increase the risk of the composite outcome (RR 7.64, 95% CI 1.24–47.06, p = 0.028). In hospitalized patients with COVID-19-related ARDS, high-dose dexamethasone rapidly improves the clinical status and decreases inflammatory biomarkers. CVD was found to increase the risk of the composite outcome. These data support the importance of randomized clinical trials with high-dose dexamethasone in COVID-19 patients.
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页码：1913 / 1919
页数：6
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  • [11] Zhao J(2020)IL-18 and infections: is there a role for targeted therapies? J Cell Physiol 236 1638-1826
  • [12] Hu Y(2021)Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19 Nat Rev Immunol 21 319-e331
  • [13] Zheng Z(2020)Remdesivir for the treatment of Covid-19 - final report N Engl J Med 383 1813-2418
  • [14] Peng F(2020)Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study Lancet Rheumatol 2 e325-40
  • [15] Xu B(2020)Observational study of hydroxychloroquine in hospitalized patients with Covid-19 N Engl J Med 382 2411-2344
  • [16] Zhao J(2020)Effect of tocilizumab vs. usual care in adults hospitalized with COVID-19 and moderate or severe pneumonia: a randomized clinical trial JAMA Intern Med 181 32-31
  • [17] Liu H(2020)Efficacy of tocilizumab in patients hospitalized with Covid-19 N Engl J Med 383 2333-276
  • [18] Peng J(2020)Effect of tocilizumab vs. standard care on clinical worsening in patients hospitalized With COVID-19 pneumonia: a randomized clinical trial JAMA Intern Med 181 24-41
  • [19] Ruan Q(2020)Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial Lancet Respir Med 8 267-267
  • [20] Yang K(1976)Prediction of creatinine clearance from serum creatinine Nephron 16 31-3330
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