The Effect of Dexamethasone on Outcome of Patients with Severe COVID-19. A Retrospective Cross Sectional Study

Introduction: Severe manifestation of Coronavirus disease 2019 (COVID-19) appears to be linked to massive inflammatory response. Glucocorticoids may help to prevent respiratory failure and death by modulating inflammation-mediated lung damage. Nonetheless, there is little conclusive evidence that it is effective in COVID-19 patients.The current study was Arch Intern Med Res 2021; 4 (4): 260-266 DOI: 10.26502/aimr.0078 Archives of Internal Medicine Research 261 proposed to see the differences in several outcomes between the severe COVID-19 patients who received usual care plus dexamethasone (the dexamethasone group), The current study was proposed to see the differences in several outcomes between the severe COVID-19 patients who received usual care plus dexamethasone (the dexamethasone group), and those who did not receive dexamethasone (the usual care group). Methods: This retrospective study was conducted at Hayatabad Medical Complex Peshawar Pakistan (Isolation units for COVID-19). Patients with severe COVID-19 admitted to hospital from March to July 2020 were included in the study. Data was collected using structured format. Mean differences were calculated using independent sample t test whereas Chi square test was used for determination of association. Results: A total of 193 patients were included in the final analysis. No significant difference in age, gender, respiratory rate, C-reactive protein, and lactate dehydrogenase between the groups was observed. Patients who received usual care plus dexamethasone were discharged earlier from hospital (8.20 ± 1.90 vs. 11.20 ± 2.40, p< 0.001), and had low percentage of mechanical ventilation (MV) requirement (15.10% vs. 28.30%, p = 0.02). Overall mortality was low in dexamethasone group, however no difference in mortality rate between both the two groups was noted (9.80% vs. 19.70%, p = 0.058). Furthermore, in comparison to the usual care group, mortality rate in patients on MV was lower in dexamethasone group (56.50% vs.23.50%, p = 0.03). Conclusion: Patient who received usual care plus dexamethasone had lower hospitalization days; proportion of patients receiving mechanical ventilation as well as days on MV was lower as compared to usual care group. Similarly, mortality in patients requiring MV was also low in dexamethasone group. Large scale experimental studies are needed to confirm these findings.