Outcomes of different steroid dosing regimens in critical covid-19 pneumonia: A retrospective cohort study
Abstract
Background; COVID-19 pandemic, from its onset in December 2019, has led to several mortalities and morbidities. In addition to these, it placed a significant load on healthcare, economies, and social systems worldwide. Unfortunately, at its onset, little was known about its effective management and many treatment options emerged. Among therapeutic options for severe and critical COVID- 19 infection, dexamethasone six milligrams once daily for ten days has demonstrated mortality benefit and is guideline recommended at this dose. In practice, variable doses of steroids have been used, especially in critical care settings. We set out to outline the pattern of steroid dosing and outcomes among critical COVID- 19 cases.
Methods; This retrospective cohort study was carried out on all eligible patients who were admitted to The Aga Khan University Hospital, Nairobi, with critical COVID-19 between March 1st, 2020, and December 31st, 2021. The study focused on the use of corticosteroids as the intervention of interest, which was quantified as the average daily dose of dexamethasone in milligrams. The study compared a steroid dose of six milligrams once a day to high-dose steroid dosing, which was defined as any dose greater than this. The primary outcome measure was critical care mortality, while secondary outcomes included the occurrence of dysglycaemias, superadded infections, and the duration of critical care admission.
Results; The study involved two hundred and eighty-eight patients, with a median age of 61.2 years (IQR: 49.7, 72.5), and 71.2% of them were male. The most common comorbidities were diabetes mellitus (60.7%), hypertension (58%), and heart disease (12.2%). Fifty- eight percent of patients received a standard dose of steroids. Although the mortality rate was higher in the high-dose group compared to the standard-dose group, the difference was not statistically significant (47.9% vs 43%, p-value=0.549). iv The two most common steroid associated adverse effects were uncomplicated hyperglycemia (62.2%) and superimposed bacterial pneumonia (20.1%). A higher incidence of uncomplicated hyperglycemia was reported in the high dose group compared to the standard-dose group (63.6% vs 61.1%). However, the incidence of diabetic ketoacidosis was lower in the high dose group (0.6% vs 6.6%).
Conclusion; The study discovered that administering high doses of steroids to critically ill COVID-19 pneumonia patients did not provide any mortality advantage and increased the risk of dysglycaemia and superimposed infections.