To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg (p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension (p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan–Meier analysis regarding the survival (log-rank p-value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.Revisión por pare

Brooks, Alexandra E.

Calderon-Rodriguez, Alex

Carcamo-Murillo, Balduino

Chambergo-Michilot, Diego

Estevez-Ramirez, Rosa

Garner, Orlando

Giron, Roberto

Montalvan-Sanchez, Eleazar

Norwood, Dalton A.

Ordonez-Montes, Jose

Palacios-Argenal, Dairy

Pineda-SanMartin, Elizabeth

Riva-Moscoso, Adrian

Rivera-Corrales, Luis

Rivera-Pineda, Shery

Rodriguez-Murillo, Aida A.

To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg (p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension (p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan-Meier analysis regarding the survival (log-rank p-value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.

Journal of Acute Medicine

High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America

English

To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg (p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension (p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan–Meier analysis regarding the survival (log-rank p-value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.Revisión por paresODS 3: Salud y BienestarODS 9: Industria, Innovación e InfraestructuraODS 10: Reducción de las Desigualdade

Repositorio Académico UPC

36     Journal of Acute Medicine 13(1) 2023Journal of Acute Medicine 13(1): 36-40, 2023DOI:10.6705/j.jacme.202303_13(1).0005Brief ReportHigh-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central AmericaEleazar Montalvan-Sanchez1,*, Diego Chambergo-Michilot2, Aida A. Rodriguez-Murillo3,  Alexandra E. Brooks1, Dairy Palacios-Argenal3, Shery Rivera-Pineda3, Jose Ordonez-Montes3,  Rosa Estevez-Ramirez3, Adrian Riva-Moscoso4, Dalton A. Norwood5, Alex Calderon-Rodriguez3,  Elizabeth Pineda-SanMartin3, Roberto Giron3, Luis Rivera-Corrales3, Balduino Carcamo-Murillo3,  Orlando Garner61 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA2	Departamento	de	Medicina,	Universidad	Cientifica	del	Sur,	Lima,	Peru3	Departamento	de	Medicina,	Universidad	Nacional	Autónoma	de	Honduras,	Tegucigalpa,	Honduras4	Departamento	de	Medicina,	Universidad	Peruana	de	Ciencias	Aplicadas,	Surco,	Peru5	Department	of	Preventive	Medicine,	The	University	of	Alabama	at	Birmingham,	Birmingham,	AL,	USA6	Pulmonology	and	Critical	Care	Medicine,	Texas	Tech	University	Health	Sciences	Center,	Permian	Basin,	TX,	USATo	compare	the	clinical	outcomes	of	a	low	dose	dexamethasone	strategy	vs.	a	high-dose	dexamethasone	strategy	in	hypoxemic	COVID-19	patients.	A	retrospective	observational	study	comparing	low-dose	(8	mg)	and	high-dose	dexamethasone	(24	mg)	of	COVID-19	patients	admitted	from	September	1,	2020	to	October	31,	2020	in	a	hospital	in	Honduras.	We	included	81	patients	with	confirmed	COVID-19	who	required	oxygen	therapy.	The	mean	age	was	similar	between	groups	(57.49	vs.	56.95	years).		There	were	more	male	patients	in	the	group	of	24	mg	(p	=	0.01).		Besides,	patients	on	the	24	mg	dose	had	more	prevalence	of	hypertension	(p =	0.052).	More	patients	in	the	24	mg	group	had	a	higher	rate	of	invasive	mechanical	ventilation	(15.00%	vs.	2.56%, p	=	0.058).	When	evaluating	the	association	between	the	high	dose	group	and	outcomes,	we	find	no	significant	association	with	mortality,	nosocomial	infections,	high	flow	mask,	invasive	mechanical	ventilation,	or	 the	need	for	vasopressors.	We	find	no	significant	differences	in	the	Kaplan–Meier	analysis	regarding	the	survival	(log-rank	p-value	=	0.315).	We	did	not	find	significant	differences	between	the	use	of	24	mg	and	8	mg	of	dexamethasone	in	hypoxemic	COVID-19	patients.	Keywords: COVID-19, corticosteroids, Western Honduras, Latin America, cohort, Latinos or HispanicReceived:	May	8,	2022;	Revised:	September	27,	2022	(2nd);	Accepted:	October	8,	2022.*	Corresponding	author:	Eleazar	Montalvan-Sanchez,	MD,	Department	of	Medicine,	Indiana	University	School	of	Medicine,	340	West	10th	Str.,	Fairbanks	Hall,	Suite	6200,	Indianapolis,	IN,	USA.	E-mail:	elmont@iu.edu	IntroductionThe	coronavirus	disease	2019	(COVID-19)	can	cause	viral	pneumonia,	which	may	progress	to	acute	respiratory	distress	syndrome,	which	 is	driven	by	a	hyperinflammatory	state.	The	cornerstone	of	therapy	against	the	severe	forms	of	COVID-19	is	therapeutics	targeted	at	reducing	this	 inflammation	and	cytokine	storm.1,2 Corticosteroids	were	 the	first	medications	 that	were	found	to	help	reduce	mortality	in	those	patients	with	COVID-19	who	required	oxygen.	The	landmark	trial	found	that	dexamethasone	at	6	mg	per	day	for	10	days	was	associated	with	decreased	mortality	com-pared	to	usual	care.1	Prior	 to	 the	RECOVERY	trial,	Villar	 et	 al.3	 had	already	 found	dexamethasone	 to	improve	outcomes	in	patients	with	acute	respiratory	distress	syndrome	but	at	a	much	higher	dose	of	20	mg	急診醫學13(1)-05 Montalvan-Sanchez(超連結).indd   36 2023/3/15   上午 10:09:23Dexamethasone and COVID-19Journal of Acute Medicine 13(1) 2023    37daily	for	five	days,	followed	by	10	mg	by	another	five	days.	To	ameliorate	 the	cytokine	storm,	dexametha-sone	has	become	the	standard	of	care	for	hypoxemic	COVID-19	patients,	coupled	with	either	interleukin-6	inhibitors	 or	 Janus	kinase	2	 (JAK2)	 inhibitors.4,5 However,	 the	 role	of	dexamethasone	has	not	been	clearly	established	in	the	question	of	whether	a	low-dose	strategy	(i.e.,	dexamethasone	at	6	mg/day)	is	su-perior	to	a	high-dose	strategy	(i.e.,	dexamethasone	at	20	mg/day),	especially	in	those	who	develop	a	critical	illness.6We	designed	a	 retrospective	 cohort	 study	 in	Western	rural	Honduras,	 the	first	and	only	study	 in	low-and	middle-income	countries	setting	from	Latin	America	 that	aims	to	compare	a	 low-dose	vs.	high-dose	strategy	and	evaluate	 if	 there	was	a	difference	between	these	two	approaches.MethodsStudy Design and PatientsWe	performed	a	 retrospective	cohort	 study	of	hypoxemic	patients	with	COVID-19	admitted	 to	a	Western	Honduran	hospital	between	09/02/2020	 to	10/31/2020.	Patients	who	were	>	18	years	of	 age	had	confirmed	SARS-CoV2	(with	PCR)	and	who	re-quired	at	least	10	L	of	oxygen	therapy	or	mechanical	ventilation	for	severe	hypoxemia.	We	excluded	pa-tients	using	corticosteroids	for	indications	other	than	COVID-19,	or	that	received	steroids	prior	to	arrival	to	the	hospital.	The	Ethics	Committee	of	Western	Hon-duras	Hospital	(Institutional	Review	Board)	approved	the	study	on	July	27,	2021	(code:	IORG0009835;	ID	approval	11680).	It	was	conducted	in	compliance	with	local	 regulations	and	 requirements,	Good	Clinical	Practice,	and	the	Declaration	of	Helsinki.	ProcedureAll patients admitted received the standard of care	established	by	 the	Honduran	health	authorities	for	COVID-19.	The	dexamethasone	dose	depended	on the time of patient admission rather than illness severity.	 In	Honduras,	 the	 shifts	 are	divided	 into	three:	 (1)	morning	shift	 from	7:00	am	to	1:00	pm,	(2)	afternoon	shift	from	1:00	pm	to	7:00	pm,	and	(3)	night	shift,	a	12-hour	shift	 to	complete	 the	24	hours	coverage.	Patients	who	came	between	7:00	am	to	1:00	pm	were	assigned	to	the	low-dose	(8	mg)	dexametha-sone	arm.		Those	who	arrived	between	1:00	pm	to	7:00	pm	were	assigned	to	the	high-dose	(24	mg)	arm.	The	night	team	admission	was	not	 included	in	the	study.	Dexamethasone	was	given	for	a	total	of	10	days.	The	doses	were	chosen	like	this	because	the	only	presentation	of	dexamethasone	available	is	8	mg	per	vial	of	 the	drug.	This	administration	pattern	did	not	depend	on	the	symptoms	or	respiratory	failure	severity.	The	head	physician	of	the	COVID-19	unit	determined	this:	the	head	staff	in	the	morning	preferred	lower	doses	of	dexamethasone,	and	the	head	staff	in	the	afternoon	chose	the	high	dose	of	dexamethasone	for	COVID-19.	At	the	moment	of	 the	study,	non-inferiority	trials	of	the	doses	of	steroids	have	been	published	in	the	med-ical	literature.	In	Honduras,	dexamethasone	vials	only	come	in	8	mg;	therefore,	national	policy	and	standard	of	care	were	to	administer	8	mg	of	dexamethasone	as	opposed	to	the	6	mg	of	dexamethasone	dose	utilized	in	the	RECOVERY	trial.1Baseline	information	was	collected	on	hospital	admission:	demographic	features,	underlying	diseas-es,	oxygen	saturation,	respiratory	rate,	C-reactive	pro-tein,	complete	blood	count,	and	erythrocyte	sedimen-tation	rate	(blood	drawn	within	two	hours	of	arrival	to	the	emergency	department).	We	followed	the	patients’	outcomes	up	to	day	28.	OutcomesThe	primary	outcome	was	mortality.	The	sec-ondary	outcomes	were	nosocomial	 infections,	 the	need	for	a	high	flow	oxygen	 therapy,	 invasive	me-chanical	ventilation,	or	the	need	for	vasopressors.Statistical AnalysisWe	used	the	percentage	for	qualitative	variables.	We	used	the	mean	or	median	to	express	the	informa-tion	of	a	quantitative	variable	according	to	its	distri-bution.	The	histogram	evaluated	the	distribution.	The	Chi-square	 test	compared	 the	qualitative	variables	among	the	two	groups.	A	 t-test	or	Mann–Whitney	U test	was	used	 to	compare	quantitative	variables	ac-cording	to	their	distribution.We	performed	Poisson	 regression	models	 to	assess	 the	association	between	 the	 intervention	and	outcomes.	The	confounders	were	baseline	clinical	and	demographic	characteristics.	Also,	we	performed	a	Kaplan–Meier	curve	to	determine	the	differences	 in	survival	between	 the	groups.	A	log-rank	p-value	of	less	than	0.05	is	a	statistically	significant	difference.急診醫學13(1)-05 Montalvan-Sanchez(超連結).indd   37 2023/3/15   上午 10:09:23Montalvan-Sanchez et al.38     Journal of Acute Medicine 13(1) 2023ResultsThere	was	a	total	of	81	patients	included	in	the	study,	with	41	 in	 the	high-dose	arm	and	40	 in	 the	low-dose	group.	The	mean	age	was	similar	between	groups	(57.49	vs.	56.95	years).	There	were	more	male	patients	 in	 the	group	of	24	mg	(p	=	0.01).	Besides,	patients	on	 the	24	mg	dose	had	more	prevalence	of	hypertension	(p	=	0.052).	Almost	no	patients	received	Remdesivir,	Tocilizumab,	or	 Interferon.	Regarding	laboratory	exams,	patients	 in	 the	24	mg	group	had	a	higher	D-dimer	median	(405	vs.	100,	p	=	0.004).	More	patients	in	the	24	mg	group	had	a	higher	rate	of	invasive	mechanical	ventilation	(15.00%	vs.	2.56%, p =	0.058)	(Table	1).When	evaluating	 the	association	between	 the	high-dose	group	and	outcomes,	we	found	no	signif-icant	association	with	mortality,	nosocomial	 infec-tions,	high-flow	oxygen	therapy,	invasive	mechanical	ventilation,	or	the	need	for	vasopressors	(Table	2).There	were	no	significant	differences	in	the	Ka-plan–Meier	curve	regarding	survival	(Log-rank	p-val-Table 1. Demographic and clinical characteristics of the included patientsVariable 24	mg	group	(n	=	41) 8	mg	group	(n	=	40) p	valueAge,	mean	(SD) 57.49	(2.57) 56.95	(2.37) 0.878aSex,	n	(%)    Male 29	(70.73) 17	(42.50) 0.01bFemale 12	(29.27) 23	(57.50)  Hypertension,	n	(%) 21	(51.22) 12	(30.00) 0.052bDiabetes 7	(17.07) 8	(20.00) 0.735bCKD 0	(0.00) 1	(2.50) 0.494cHF 1	(2.44) 1	(2.50) 0.747cRemdesivir	use 0	(0.00) 1	(2.50) 0.494cTocilizumab	use 1	(2.44) 0	(0.00) 0.506cInterferon	use 1	(2.44) 2	(5.00) 0.491cMaximum	RR,	mean	(SD)d 29.025	(6.99) 27.55	(5.12) 0.285aMinimum	neutrophil	count,	mean	(SD)d 7,649.8	(516.00) 6,326.535	(644.25) 0.1129aMinimum	lymphocyte	count,	median	(IQR)d 980	(700–1,200) 838.5	(499.5–1,325) 0.603eMaximum	CRP,	median	(IQR)d 46	(12–96) 24	(18–96) 0.617eMaximun	ESR,	mean	(SD)d 32.525	(2.53) 36.7	(2.56) 0.247aMaximum	LDH,	median	(IQR)f 406	(0–550) 405.5	(35–617) 0.368eMaximum	ferritin	median	(IQR)f 341	(0–609) 368	(42–867) 0.445eMaximum	D-dimer	median	(IQR)f 100	(0–282) 405	(100–717) 0.004eMaximum	procalcitonin	median	(IQR)f 0.25	(0–0.29) 0.25	(0.25–0.322) 0.238eHigh	flow	maskd,	n	(%) 14	(35.00) 7	(17.95) 0.086bInvasive mechanical ventilationd,	n	(%) 6	(15.00) 1	(2.56) 0.058cNeed of vasopressorsd 1	(2.50) 1	(2.56) 0.747cNosocomial infectionf 8	(21.62) 14	(40.00) 0.091bAlive 35	(85.37) 38	(95.00) 0.140ca	Calculated	using	t-test.b	Calculated	using	Chi	squared	test.c	Calculated	using	Fisher’s	exact	test.d	≤	10%	observations	lost	in	one	or	both	groups.e	Calculated	using	Mann	Whitney	U	test.f	One	group	or	both	has	>	10%	of	observations	lost.CKD:	chronic	kidney	disease;	CRP:	C-reactive	protein;	ESR:	erythrocyte	sedimentation	rate;	HF:	heart	failure;	IQR:	interquartile	range;	LDH:	lactate	dehydrogenase;	RR:	respiratory	rate;	SD:	standard	deviation.急診醫學13(1)-05 Montalvan-Sanchez(超連結).indd   38 2023/3/15   上午 10:09:23Dexamethasone and COVID-19Journal of Acute Medicine 13(1) 2023    39ue	=	0.315).		However,	from	day	15,	the	8	mg	group	seemed	to	have	better	survival	(Fig.	1).DiscussionWe	found	no	significant	difference	in	mortality	between	the	two	strategies,	but	it	seems	that	patients	in	 the	high-dose	arm	had	higher	D-dimers	and	 re-quired	mechanical	ventilation	more	often.	The	optimal	dose	of	dexamethasone	 remains	controversial,	especially	for	those	who	are	escalating	in	oxygen	requirements	quickly.	Although	 the	RE-COVERY	trial	has	confirmed	 the	usefulness	of	 the	drug	in	hypoxemic	COVID-19	patients,	the	study	was	conducted	in	most	European	populations,	which	may	not	be	adequately	translated	to	Latin	American	coun-tries.1	The	CoDEX	study	was	conducted	 in	a	Latin	American	patient,	similar	to	our	study	population,	and	was	one	of	 the	first	 trials	 to	utilize	dexamethasone,	although	at	a	higher	dose	(i.e.,	20	mg	for	five	days	then	tapered	to	10	mg	for	five	days,	after	which	it	was	stopped)7	 than	 the	RECOVERY	trial.	This	strategy	was	similar	 to	 the	one	utilized	in	 the	DEXA-ARDS	study	that	found	reduced	ventilator-free	days	 in	pa-tients	 treated	with	dexamethasone	as	opposed	to	the	standard	of	care.8	Higher	D-dimers	suggested	a	higher	level	of	inflammation	and	lung	injury,	signifying	that	patients	with	higher	levels	were	sicker	than	their	low	D-dimer	counterparts.	Log-rank p-value = 0.315Fig. 1. Kaplan–Meier analysis of survival according to the dexamethasone group.[The	colored	figure	is	used	in	the	online	version,	available	on	the	website	http://doi.org/10.6705/j.jacme.202303_13(1).0005]Table 2. Patient outcomes with different levels of organ support OutcomeCrude	model Adjusted	modelaRR 95%	CI RR 95%	CIMortality 2.93 0.59–14.50 5.18 0.47–57.52Nosocomial infections 0.87 0.58–1.30 0.85 0.55–1.33High	flow	oxygen	therapy 1.15 0.77–1.70 1.14 0.73–1.77Mechanical ventilation 1.12 0.73–1.71 1.10 0.69–1.76Need of vasopressors 0.99 0.65–1.55 0.99 0.61–1.62a	This	model	was	adjusted	by	age,	sex,	hypertension,	diabetes,	chronic	kidney	disease,	heart	failure,	remdesivir	use,	tocilizumab	use,	and	interfer-on	use.CI:	confidence	interval;	RR:	relative	risk.急診醫學13(1)-05 Montalvan-Sanchez(超連結).indd   39 2023/3/15   上午 10:09:26Montalvan-Sanchez et al.40     Journal of Acute Medicine 13(1) 2023Our	paper	 is	 remarkable	because	 it	 contrasts	both	strategies	in	a	Latin	American	cohort	and	found	no	difference	in	outcomes	in	mortality.	These	findings	are	similar	 to	other	studies	that	have	compared	high	and	 low-dose	strategies	 for	COVID-19,	suggesting	that	an	increased	dose	of	dexamethasone	does	not	im-pact	patient	outcomes	in	a	significant	manner.	A	trial	comparing	6	mg	vs.	12	mg	of	dexamethasone	did	not	find	the	higher	dose	to	impact	outcomes,6 and another trial	that	compared	doses	higher	than	20	mg	of	dexa-methasone	(i.e.,	dexamethasone	40	mg/day	and	meth-ylprednisolone	500	mg/day)	found	that	the	lower	dose	(<	6	mg/day)	of	dexamethasone	improved	outcomes.9 Although	it	 is	unclear	why	higher	doses	do	not	 im-prove	mortality	or	ventilator-free	days,	this	could	be	explained	by	possible	adverse	effects	of	therapy,	such	as	the	risk	of	opportunistic	infections	and	hyperglyce-mia.	Although	 these	 results	 favor	 low-dose	strate-gies,	 the	optimal	dose	 is	still	unclear	since	a	recent	Argentina	study	found	that	high-dose	dexamethasone	decreased	ventilator	days	 in	a	cohort	of	COVID-19	patients.10	 It	could	be	argued	 that	patient	selection	plays	a	role	in	who	will	benefit	from	lower	to	higher	doses	of	steroids.	Our	study	has	many	limitations,	such	as	being	unblinded,	single-center,	and	two	different	treatment	teams	(morning	and	afternoon	shifts),	which	places	a	risk	for	selection	and	observer	bias.	Furthermore,	the	investigators	did	not	fill	the	data	collection	sheet	but	rather	by	physicians	taking	care	of	the	patients,	which	also	lends	itself	 to	possible	confounding	bias.	Final-ly,	our	paper	had	a	small	sample	size	that	might	not	detect	any	difference.	Most	of	our	patients	did	not	re-ceive	any	other	immunomodulating	agent	(IL-6i	and	JAK2i)	that	might	impact	outcomes	in	these	patients.	We	believe	that	our	paper	is	significant	since	it	studies	an	underrepresented	population	in	medical	 literature	and	helps	delineate	strategies	for	low-middle-income	countries	who	might	not	be	able	 to	afford	more	ex-pensive	agents	to	dampen	cytokine	storms.	In	conclusion,	the	higher	dose	of	dexamethasone	does	not	seem	to	decrease	mortality	in	this	single-cen-ter	observational	study,	but	further	randomized	trials	are	necessary	 to	find	a	possible	difference	between	strategies.	References1. The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with covid-19—preliminary re-port. N Engl J Med 2021;384:693-704. doi:10.1056/NEJ-Moa20214362. Fajgenbaum DC, June CH. Cytokine storm. N Engl J Med 2020;383:2255-2273. doi:10.1056/NEJMra20261313. Villar J, Ferrando C, Martínez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med 2020;8:267-276. doi:10.1016/S2213-2600(19)30417-54. Rosas IO, Bräu N, Waters M, et al. Tocilizumab in hospi-talized patients with severe covid-19 pneumonia. N Engl J Med 2021;384:1503-1516. doi:10.1056/NEJMoa20287005. Cao Y, Wei J, Zou L, et al. Ruxolitinib in treatment of severe coronavirus disease 2019 (COVID-19): a mul-ticenter, single-blind, randomized controlled trial. J Allergy Clin Immunol 2020;146:137-146.e3. doi:10.1016/j.jaci.2020.05.0196. COVID STEROID 2 Trial Group, Munch MW, Myatra SN, et al. Effect of 12 mg vs 6 mg of dexamethasone on the number of days alive without life support in adults with COVID-19 and severe hypoxemia: the COVID STE-ROID 2 Randomized Trial. JAMA 2021;326:1807-1817. doi:10.1001/jama.2021.182957. Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of dexamethasone on days alive and ventilator-free in pa-tients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX randomized clinical trial. JAMA 2020;324:1307-1316. doi:10.1001/jama.2020.170218. Villar J, Belda J, Añón JM, et al. Evaluating the efficacy of dexamethasone in the treatment of patients with per-sistent acute respiratory distress syndrome: study proto-col for a randomized controlled trial. Trials 2016;17:342. doi:10.1186/s13063-016-1456-49. Jamil Z, Almajhdi FN, Khalid S, Asghar M, Ahmed J, Wa-heed Y. Comparison of low-versus high-dose steroids in the clinical outcome of hospitalized COVID-19 patients. Antibiotics (Basel) 2021;10:1510. doi:10.3390/antibiot-ics1012151010. Maskin LP, Bonelli I, Olarte GL, et al. High-versus low-dose dexamethasone for the treatment of COVID-19-re-lated acute respiratory distress syndrome: a multicenter, randomized open-label clinical trial. J Intensive Care Med 2022;37:491-499. doi:10.1177/08850666211066799急診醫學13(1)-05 Montalvan-Sanchez(超連結).indd   40 2023/3/15   上午 10:09:26

To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg ( p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension ( p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan–Meier analysis regarding the survival (log-rank p -value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients

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High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America

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