Association of early dexamethasone therapy with mortality in critically Ill COVID-19 patients: a French multicenter study

Matthieu Raymond; Aurélie Le Thuaut; Pierre Asfar; Cédric Darreau; Florian Reizine; Gwenhaël Colin; Charly Dano; Julien Lorber; Baptiste Hourmant; Agathe Delbove; Aurélien Frérou; Jean Morin; Pierre Yves Egreteau; Philippe Seguin; Jean Reignier; Jean-Baptiste Lascarrou; Emmanuel Canet

doi:10.1186/s13613-022-01074-w

Association of early dexamethasone therapy with mortality in critically Ill COVID-19 patients: a French multicenter study

Ann Intensive Care. 2022 Oct 29;12(1):102. doi: 10.1186/s13613-022-01074-w.

Authors

Matthieu Raymond¹, Aurélie Le Thuaut², Pierre Asfar³, Cédric Darreau⁴, Florian Reizine⁵, Gwenhaël Colin⁶, Charly Dano⁷, Julien Lorber⁸, Baptiste Hourmant⁹, Agathe Delbove¹⁰, Aurélien Frérou¹¹, Jean Morin¹², Pierre Yves Egreteau¹³, Philippe Seguin¹⁴, Jean Reignier¹, Jean-Baptiste Lascarrou¹, Emmanuel Canet¹⁵

Affiliations

¹ Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
² Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France.
³ Service de Médecine Intensive Reanimation, CHU d'Angers, Angers, France.
⁴ Service de Réanimation Polyvalente, CH du Mans, Le Mans, France.
⁵ Service de Médecine Intensive Réanimation, CHU de Rennes, Rennes, France.
⁶ Service de Médecine Intensive Réanimation, CHD de La Roche Sur Yon, La Roche-Sur-Yon, France.
⁷ Service de Réanimation Polyvalente, CH de Cholet, Cholet, France.
⁸ Service de Réanimation Polyvalente, CH de Saint Nazaire, Saint-Nazaire, France.
⁹ Service de Médecine Intensive Réanimation, CHU de Brest, Brest, France.
¹⁰ Service de Réanimation Polyvalente, CH de Vannes, Vannes, France.
¹¹ Service de Réanimation Polyvalente, CH de Saint Malo, Saint Malo, France.
¹² Unité de Soins Intensifs de Pneumologie, CHU de Nantes, Nantes, France.
¹³ Service de Réanimation Polyvalente, CH de Morlaix, Morlaix, France.
¹⁴ Service de Réanimation Chirurgicale, CHU de Rennes, Rennes, France.
¹⁵ Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. emmanuel.canet@chu-nantes.fr.

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: COVID-19; Dexamethasone; Intubation; Mortality; Ventilator-associated pneumonia.