Associations between corticosteroid dosage and clinical outcomes in patients with hypoxemic COVID-19 pneumonia: A retrospective cohort study
Issued Date
2024-09-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-85203308997
Journal Title
PLoS ONE
Volume
19
Issue
9
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLoS ONE Vol.19 No.9 (2024)
Suggested Citation
Teeratakulpisarn N., Chiewroongroj S., Naorungroj T., Ratanarat R. Associations between corticosteroid dosage and clinical outcomes in patients with hypoxemic COVID-19 pneumonia: A retrospective cohort study. PLoS ONE Vol.19 No.9 (2024). doi:10.1371/journal.pone.0308069 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/101200
Title
Associations between corticosteroid dosage and clinical outcomes in patients with hypoxemic COVID-19 pneumonia: A retrospective cohort study
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Abstract
Background Corticosteroids are commonly used to treat COVID-19 patients with hypoxemia, and clinicians have adjusted the corticosteroid intensity on the basis of clinical needs. However, neither the optimal dose nor the duration of treatment has been recommended. Objective To investigate whether cumulative doses of corticosteroids, measured as dexamethasone-equivalent doses over the first 14 days, impact outcomes in patients with COVID-19 pneumonia. Methods We conducted a retrospective cohort study of COVID-19 pneumonia patients admitted between April 1st, 2020, and September 30th, 2021. The study focused on the type and dose of corticosteroid administered during the initial 14 days, clinical outcomes, and complications. The primary outcome was in-hospital mortality. Results Among 271 patients, the mean cumulative dexamethasone-equivalent dose was 158 (119.9–197.25) mg in survivors and 185 (131.7–222.0) mg in nonsurvivors. Univariate analysis revealed that the cumulative dexamethasone-equivalent dose was a risk factor for in-hospital mortality. However, this association did not hold true in the multivariate analysis. After the cumulative dexamethasone-equivalent dose was categorized into quartiles, the moderate dosage (126.01–165.00 mg) in the second quartile was found to be associated with the lowest in-hospital mortality (16.2%). Higher cumulative dexamethasone-equivalent doses were associated with longer hospital and ICU stays and fewer ventilator-free days (p < 0.001). Doses exceeding 165 mg were associated with an increased risk of hospital-acquired infections (p < 0.001). Conclusions The cumulative dexamethasone-equivalent dose during the first 14 days is not associated with in-hospital mortality in hypoxemic COVID-19 patients. However, higher cumulative doses exceeding 165 mg are associated with an increased risk of in-hospital mortality and secondary hospital-acquired infections.