BMC Pulmonary Medicine (Aug 2023)

Evaluation of the use of methylprednisolone and dexamethasone in asthma critically ill patients with COVID-19: a multicenter cohort study

  • Khalid Al Sulaiman,
  • Ohoud Aljuhani,
  • Ghazwa B. Korayem,
  • Ali Altebainawi,
  • Reham Alharbi,
  • Maha Assadoon,
  • Ramesh Vishwakarma,
  • Nadia H. Ismail,
  • Asma A. Alshehri,
  • Faisal E. Al Mutairi,
  • Mashael AlFaifi,
  • Abdullah F. Alharthi,
  • Abeer A. Alenazi,
  • Mai Alalawi,
  • Omar Al Zumai,
  • Hussain Al Haji,
  • Sarah T. Al Dughaish,
  • Abdulrahman S. Alawaji,
  • Haifa A. Alhaidal,
  • Ghassan Al Ghamdi

DOI
https://doi.org/10.1186/s12890-023-02603-4
Journal volume & issue
Vol. 23, no. 1
pp. 1 – 10

Abstract

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Abstract Background Previous studies have shown mortality benefits with corticosteroids in Coronavirus disease-19 (COVID-19). However, there is inconsistency regarding the use of methylprednisolone over dexamethasone in COVID-19, and this has not been extensively evaluated in patients with a history of asthma. This study aims to investigate and compare the effectiveness and safety of methylprednisolone and dexamethasone in critically ill patients with asthma and COVID-19. Methods The primary endpoint was the in-hospital mortality. Other endpoints include 30-day mortality, respiratory failure requiring mechanical ventilation (MV), acute kidney injury (AKI), acute liver injury, length of stay (LOS), ventilator-free days (VFDs), and hospital-acquired infections. Propensity score (PS) matching, and regression analyses were used. Results A total of one hundred-five patients were included. Thirty patients received methylprednisolone, whereas seventy-five patients received dexamethasone. After PS matching (1:1 ratio), patients who received methylprednisolone had higher but insignificant in-hospital mortality in both crude and logistic regression analysis, [(35.0% vs. 18.2%, P = 0.22) and (OR 2.31; CI: 0.56 – 9.59; P = 0.25), respectively]. There were no statistically significant differences in the 30-day mortality, respiratory failure requiring MV, AKI, acute liver injury, ICU LOS, hospital LOS, and hospital-acquired infections. Conclusions Methylprednisolone in COVID-19 patients with asthma may lead to increased in-hospital mortality and shorter VFDs compared to dexamethasone; however, it failed to reach statistical significance. Therefore, it is necessary to interpret these data cautiously, and further large-scale randomized clinical trials are needed to establish more conclusive evidence and support these conclusions.

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