Effect of dexamethasone dose on outcomes in acute COVID-19 disease: A systematic review and meta-analysis - 23/11/23
, Nishkantha Arulkumaran a, 2, Mervyn Singer a, 3, Sang-Ho Choi a, b, 4
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Summary |
Introduction |
The impact of different doses of dexamethasone on outcomes from acute COVID-19 pneumonia is unknown.
Methods |
We performed a systematic review and meta-analysis of randomised control trials comparing different doses of dexamethasone in adult patients with COVID-19. High dose dexamethasone treatment was defined as 12–24 mg daily, whereas low-dose treatment was 6–8 mg daily. Primary outcome was 28-day mortality.
Results |
Eight trials including 3469 patients were identified, with 1775 patients receiving high dose dexamethasone. There was no difference in mortality between patients receiving high dose or low-dose dexamethasone (22.0% vs. 20.2%; odds ratio 1.20 [95% confidence interval 0.86–1.67]; p = 0.29; I2 = 63%; TSA-adjusted CI [0.31–4.66]; very low QoE). Meta-regression did not demonstrate a dose-dependent effect of steroids on mortality. High dose dexamethasone was associated with an increased risk of hyperglycaemia (23.6% vs. 17.2%; 1.51 [1.19–1.92]; p = 0.0008; I2 = 0%; TSA-adjusted CI [0.90–2.54]; low QoE) but not secondary infections (14.3% vs. 15.0%; 0.87 [0.56–1.37]; p = 0.56; I2 = 72%; very low QoE). Risk of bias was low for seven of the eight studies.
Conclusions |
The mortality of patients with acute COVID-19 receiving high-dose dexamethasone is similar to patients receiving low-dose dexamethasone, although high-dose dexamethasone is associated with an increased risk of hyperglycaemia.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The impact of different doses of dexamethasone on outcomes from acute COVID-19 pneumonia is unknown. |
• | In this meta-analysis of eight randomised control trials, high-dose dexamethasone was associated with similar mortality rates to low-dose. |
• | Higher doses may be associated with an increased risk of hyperglycaemia but not secondary infection. |
• | Ongoing research should investigate the effects of different doses of dexamethasone in non-COVID-19 ARDS. |
Keywords : Dexamethasone, Acute respiratory distress syndrome, COVID-19, Systematic review, Meta-analysis
Plan
Vol 87 - N° 6
P. 490-497 - décembre 2023 Retour au numéro
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