ABSTRACT
Background. Anti-inflammatory agents like dexamethasone (DEX) have become a mainstay of treatment for COVID-19. Despite randomized trials demonstrating that a 6 mg daily dose of DEX improved patient outcomes in hospitalized COVID-19 patients receiving oxygen, clinicians often prescribe higher doses of corticosteroids without evidence to support this practice. The purpose of this study was to compare outcomes of ventilated COVID-19 patients who received standard dose (SD) versus high dose (HD) DEX. Methods. This was a multi-site, retrospective, observational study of ventilated COVID-19-positive patients who received at least three days of DEX between June 1, 2020 and January 31, 2022. Sample size was calculated based on a 3:1 high:standarddose prescribing pattern ratio. The primary outcome of this study was the association between mortality and SD (<6mg daily) versus HD ( >10mg daily) DEX in ventilated COVID-19 patients. Secondary outcomes included average blood glucose (BG), number of BG readings above 200, incidence of bacterial nosocomial infection, ventilatorfree days, length of stay (LOS) and ICU LOS. Results. Of 322 patients screened, 110 were excluded primarily for average daily DEX dose of > 6 to <= 10mg. Of the 212 included patients, 53 (25%) received SD DEX and 159 (75%) received HD DEX. Data demonstrate no significant effect of DEX dose on mortality, number of BG readings > 200, incidence of nosocomial infections, LOS, or ventilator-free days (p >0.05). After controlling for confounding factors no difference in mortality persisted (OR 1.45 95% CI 0.66- 3.20). Average daily BG and ICU LOS were significantly greater in the HD group compared to the SD group (p = 0.003, p = 0.019 respectively). Conclusion. There is no association betweenHDDEX and mortality among ventilated COVID-19 patients compared to SD DEX. Moreover, HD DEX is associated with detrimental effects such as prolonged ICU LOS and higher average daily BG. This study supports the use of SD DEX in ventilated COVID-19 patients.