Service analysis examining the outcomes based on dexamethasone duration in Covid patients requiring oxygen in UKhospital

ABSTRACT

Background: Recent RECOVERY trial showed use of dexamethasone lead to reduction in 28 days mortality in patients with COVID pneumonia requiring oxygen. NICE recommends offering dexamethasone for 10 days in patients with COVID positive pneumonia. However, outcomes from real world data are lacking. Aim: The aim of this study was to analyse the impact of different duration of dexamethasone on mortality rate in patients with COVID positive pneumonia requiring oxygen. Method: The study was performed retrospectively from single centre using electronic PICS (prescribing information and communication system). We included patients admitted in hospital between the periods of 29/12/2020 to 7/1/2021 with diagnosis of COVID pneumonia, requiring dexamethasone. Data extracted included patient demographics, diabetes status and number of days on dexamethasone. We evaluated outcomes in three groups based on duration of dexamethasone as Group A (10 days), Group B (4-9 days) and Group C (≤3 days). Primary outcomes were mortality rate and length of stay. Results: We identified 179 patients. Mean (SD) age was 65 (17) years, 45.8% were female. Mean BMI was 31(14) kg/m2, 56.9% were Caucasian, 18.9% South Asian,4.4% were Afro-Caribbean,46.9% had diabetes. 128 patients were nursed on general medical ward (GIM) and 51 patients needed ITU setting. The mortality rate was 25 %, 20% and 43.7% in group A, B and C respectively. Mean length of stay (LOS) was 9 (11) days,10 (7) days and 9 (6) days in group A, B and C respectively. Further analysis of patients nursed on GIM ward showed mortality rate of 11.9%, 25% and 66.6% in group A, B and C suggesting an association between longer duration of dexamethasone and reduction in mortality. No difference in LOS was noted. No similar analysis was conducted in patients nursed on ITU setting because of small sample size. Discussion: Longer duration of dexamethasone was associated with better mortality rate in patients nursed on GIM ward and hence we should offer full course of 10 days dexamethasone in patients admitted with Covid pneumonia requiring oxygen. However, our study had small sample size, from single centre and result was not adjusted for co-variables like age, gender, BMI, and amount of oxygen requirement. We need future study with large sample size, multicentre and addressing these limitations.