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Association of early dexamethasone therapy with mortality in critically Ill COVID-19 patients: a French multicenter study.
Raymond, Matthieu; Le Thuaut, Aurélie; Asfar, Pierre; Darreau, Cédric; Reizine, Florian; Colin, Gwenhaël; Dano, Charly; Lorber, Julien; Hourmant, Baptiste; Delbove, Agathe; Frérou, Aurélien; Morin, Jean; Egreteau, Pierre Yves; Seguin, Philippe; Reignier, Jean; Lascarrou, Jean-Baptiste; Canet, Emmanuel.
  • Raymond M; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
  • Le Thuaut A; Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France.
  • Asfar P; Service de Médecine Intensive Reanimation, CHU d'Angers, Angers, France.
  • Darreau C; Service de Réanimation Polyvalente, CH du Mans, Le Mans, France.
  • Reizine F; Service de Médecine Intensive Réanimation, CHU de Rennes, Rennes, France.
  • Colin G; Service de Médecine Intensive Réanimation, CHD de La Roche Sur Yon, La Roche-Sur-Yon, France.
  • Dano C; Service de Réanimation Polyvalente, CH de Cholet, Cholet, France.
  • Lorber J; Service de Réanimation Polyvalente, CH de Saint Nazaire, Saint-Nazaire, France.
  • Hourmant B; Service de Médecine Intensive Réanimation, CHU de Brest, Brest, France.
  • Delbove A; Service de Réanimation Polyvalente, CH de Vannes, Vannes, France.
  • Frérou A; Service de Réanimation Polyvalente, CH de Saint Malo, Saint Malo, France.
  • Morin J; Unité de Soins Intensifs de Pneumologie, CHU de Nantes, Nantes, France.
  • Egreteau PY; Service de Réanimation Polyvalente, CH de Morlaix, Morlaix, France.
  • Seguin P; Service de Réanimation Chirurgicale, CHU de Rennes, Rennes, France.
  • Reignier J; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
  • Lascarrou JB; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
  • Canet E; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. emmanuel.canet@chu-nantes.fr.
Ann Intensive Care ; 12(1): 102, 2022 Oct 29.
Article in English | MEDLINE | ID: covidwho-2098453
ABSTRACT

BACKGROUND:

Dexamethasone is recommended for COVID-19 patients who require oxygen therapy. However, its effectiveness in reducing mortality and intubation, and its safety, remain debated. We aimed to investigate whether dexamethasone reduces day-28 mortality in unselected patients with critical COVID-19.

METHODS:

We performed an observational cohort study in consecutive COVID-19 patients admitted to any of 13 French intensive care units (ICUs) in 2020. The primary objective was to determine whether early dexamethasone therapy was associated with day-28 mortality and the secondary objectives were to assess whether early dexamethasone decreased intubation requirements and to collect adverse events.

RESULTS:

Of 1058 included patients, 611 (57.75%) received early dexamethasone (early dexamethasone group), 358 (33.83%) did not receive any steroids (no steroids group), and 89 (8.41%) received late dexamethasone or other steroids. Day-28 mortality was similar between the early dexamethasone and the no steroids groups (15.06% and 14.25%, respectively; P = 0.59). Factors associated with day-28 mortality were older age (adjusted hazard ratio [aHR], 1.06; 1.04-1.09; P < 0.001), worse SOFA score (aHR, 1.13; 1.06-1.20; P < 0.001), and immunocompromised status (aHR, 1.59; 1.01-2.50; P = 0.043). Early dexamethasone was associated with fewer intubations (48.55% vs. 61.49%, P < 0.001) and more ventilator-free days by day 28 (22 [2-28] vs. 17 [1-28] days, P = 0.003), compared to no steroids. Ventilator-associated pneumonia (VAP) was more common with early dexamethasone (HR, 1.29 [1.01-1.63], P = 0.04) than with no steroids, whereas no differences were noted for bloodstream infection, fungal infection, or gastrointestinal bleeding.

CONCLUSIONS:

Early dexamethasone in critically ill COVID-19 patients was not associated with lower day-28 mortality. However, early dexamethasone was associated with lower intubation needs and more ventilator-free days by day 28. In patients treated with invasive mechanical ventilation, early dexamethasone was associated with a higher risk of VAP.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Ann Intensive Care Year: 2022 Document Type: Article Affiliation country: S13613-022-01074-w

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Ann Intensive Care Year: 2022 Document Type: Article Affiliation country: S13613-022-01074-w