Journal of Microbiology, Immunology and Infection (Jun 2024)
Effect of early dexamethasone on outcomes of COVID-19: A quasi-experimental study using propensity score matching
- Wang-Da Liu,
- Jann-Tay Wang,
- Ming-Chieh Shih,
- Kai-Hsiang Chen,
- Szu-Ting Huang,
- Chun-Fu Huang,
- Tien-Hao Chang,
- Ming-Jui Tsai,
- Po-Hsien Kuo,
- Yi-Chen Yeh,
- Wan-Chen Tsai,
- Mei-Yan Pan,
- Guei-Chi Li,
- Yi-Jie Chen,
- Kuan-Yin Lin,
- Yu-Shan Huang,
- Aristine Cheng,
- Pao- Yu Chen,
- Sung-Ching Pan,
- Hsin-Yun Sun,
- Shih-Chi Ku,
- Sui-Yuan Chang,
- Wang-Huei Sheng,
- Chi-Tai Fang,
- Chien-Ching Hung,
- Yee-Chun Chen,
- Yi-Lwun Ho,
- Ming-Shiang Wu,
- Shan-Chwen Chang
Affiliations
- Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
- Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan; Corresponding author. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 8 Zhongshan South Road, Taipei 100225, Taiwan.
- Ming-Chieh Shih
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
- Kai-Hsiang Chen
- Department of Internal Medicine, National Taiwan University Hsinchu Branch, Hsinchu, Taiwan
- Szu-Ting Huang
- Department of Internal Medicine, National Taiwan University Hsinchu Branch, Hsinchu, Taiwan
- Chun-Fu Huang
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- Tien-Hao Chang
- Taiwan Centers for Disease Control, Taiwan
- Ming-Jui Tsai
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- Po-Hsien Kuo
- Department of Internal Medicine, National Taiwan University Hsinchu Branch, Hsinchu, Taiwan
- Yi-Chen Yeh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- Wan-Chen Tsai
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- Mei-Yan Pan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- Guei-Chi Li
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Yi-Jie Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Kuan-Yin Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Pao- Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Sui-Yuan Chang
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Chi-Tai Fang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Corresponding author. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei 10055, Taiwan.
- Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Yi-Lwun Ho
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Journal volume & issue
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Vol. 57,
no. 3
pp. 414 – 425
Abstract
Background: The RECOVERY trial demonstrated that the use of dexamethasone is associated with a 36% lower 28-day mortality in hospitalized patients with COVID-19 on invasive mechanical ventilation. Nevertheless, the optimal timing to start dexamethasone remains uncertain. Methods: We conducted a quasi-experimental study at National Taiwan University Hospital (Taipei, Taiwan) using propensity score matching to simulate a randomized controlled trial to receive or not to receive early dexamethasone (6 mg/day) during the first 7 days following the onset of symptoms. Treatment was standard protocol-based, except for the timing to start dexamethasone, which was left to physicians’ decision. The primary outcome is 28-day mortality. Secondary outcomes include secondary infection within 60 days and fulfilling the criteria of de-isolation within 20 days. Results: A total of 377 patients with COVID-19 were enrolled. Early dexamethasone did not decrease 28-day mortality in all patients (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.97–1.10) or in patients who required O2 for severe/critical disease at admission (aOR, 1.05; 95%CI, 0.94–1.18); but is associated with a 24% increase in superinfection in all patients (aOR, 1.24; 95% CI, 1.12–1.37) and a 23% increase in superinfection in patients of O2 for several/critical disease at admission (aOR, 1.23; 95% CI, 1.02–1.47). Moreover, early dexamethasone is associated with a 42% increase in likelihood of delayed clearance of SARS-CoV-2 virus (adjusted hazard ratio, 1.42; 95% CI, 1.01–1.98). Conclusion: An early start of dexamethasone (within 7 days after the onset of symptoms) could be harmful to hospitalized patients with COVID-19.
