Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Oct;87(10):3766-3775.
doi: 10.1111/bcp.14784. Epub 2021 Mar 10.

Dexamethasone use and mortality in hospitalized patients with coronavirus disease 2019: A multicentre retrospective observational study

Nicolas Hoertel  1   2   3 , Marina Sánchez-Rico  1   4 , Raphaël Vernet  5 , Nathanaël Beeker  6 , Antoine Neuraz  7   8 , Jesús M Alvarado  4 , Christel Daniel  9   10 , Nicolas Paris  9   11 , Alexandre Gramfort  12 , Guillaume Lemaitre  12 , Elisa Salamanca  13 , Mélodie Bernaux  14 , Ali Bellamine  15 , Anita Burgun  7 , Frédéric Limosin  1   2   3 ; AP-HP/Université de Paris/INSERM Covid-19 research collaboration and AP-HP Covid CDR Initiative
Affiliations
Observational Study

Dexamethasone use and mortality in hospitalized patients with coronavirus disease 2019: A multicentre retrospective observational study

Nicolas Hoertel et al. Br J Clin Pharmacol. 2021 Oct.

Abstract

Aims: To examine the association between dexamethasone use and mortality among patients hospitalized for COVID-19.

Methods: We examined the association between dexamethasone use and mortality at AP-HP Greater Paris University hospitals. Study baseline was defined as the date of hospital admission. The primary endpoint was time to death. We compared this endpoint between patients who received dexamethasone and those who did not in time-to-event analyses adjusted for patient characteristics (such as age, sex and comorbidity) and clinical and biological markers of clinical severity of COVID-19, and stratified by the need for respiratory support, i.e. mechanical ventilation or oxygen. The primary analysis was a multivariable Cox regression model.

Results: Of 12 217 adult patients hospitalized with a positive COVID-19 reverse transcriptase-polymerase chain reaction test, 171 (1.4%) received dexamethasone orally or by intravenous perfusion during the visit. Among patients who required respiratory support, the end-point occurred in 10/63 (15.9%) patients who received dexamethasone and 298/1129 (26.4%) patients who did not. In this group, there was a significant association between dexamethasone use and reduced mortality in the primary analysis (hazard ratio, 0.46; 95% confidence interval 0.22-0.96, P = .039). Among patients who did not require respiratory support, there was no significant association between dexamethasone use and the endpoint.

Conclusions: In this multicentre observational study, dexamethasone use administered either orally or by intravenous injection at a cumulative dose between 60 mg and 150 mg was associated with reduced mortality among patients with COVID-19 requiring respiratory support.

Keywords: COVID-19; SARS-CoV-2; dexamethasone; efficacy; mortality; oxygen; treatment; ventilation.

PubMed Disclaimer

Conflict of interest statement

Dr Hoertel has received personal fees and nonfinancial support from Lundbeck, outside the submitted work. Dr Limosin has received speaker and consulting fees from Janssen‐Cilag outside the submitted work. Other authors declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Study cohort
FIGURE 2
FIGURE 2
Association between dexamethasone use and time to death in the full sample and in the matched analytic sample. * P‐value is significant (P < .05). HR, hazard ratio; CI, confidence interval
FIGURE 3
FIGURE 3
Kaplan–Meier curves for time to death in the full samples of patients hospitalized for COVID‐19 who required respiratory support (i.e. mechanical ventilation or oxygen; n = 1192; A), and of those who did not (n = 11 018; B), according to dexamethasone use. The shaded areas represent pointwise 95% confidence intervals
FIGURE 4
FIGURE 4
Kaplan–Meier curves for time to death in the matched analytic samples of patients hospitalized for COVID‐19 who required respiratory support (i.e. mechanical ventilation or oxygen; n = 693; A) and of those who did not (n = 1188; B), according to dexamethasone use. The shaded areas represent pointwise 95% confidence intervals. For each exposed case, 10 nonexposed controls were selected
See this image and copyright information in PMC

References

    1. Hoertel N, Blachier M, Blanco C, et al. A stochastic agent‐based model of the SARS‐CoV‐2 epidemic in France. Nat Med. 2020;26(9):1417‐1421. 10.1038/s41591-020-1001-6 - DOI - PubMed
    1. Hoertel N, Blachier M, Blanco C, et al. Facing the COVID‐19 epidemic in NYC: a stochastic agent‐based model of various intervention strategies. medRxiv. Published online. 2020. 10.1101/2020.04.23.20076885 - DOI
    1. Chevance A, Gourion D, Hoertel N, et al. Ensuring mental health care during the SARS‐CoV‐2 epidemic in France: A narrative review. L'Encephale. 2020;46(3S):193‐201. 10.1016/j.encep.2020.03.001 - DOI - PMC - PubMed
    1. Hoertel N, Blachier M, Sánchez‐Rico M, Limosin F, Leleu H. Impact of the timing and adherence to face mask use on the course of the COVID‐19 epidemic in France. J Travel Med. 2021;28(2):taab016. 10.1093/jtm/taab016 - DOI - PMC - PubMed
    1. RECOVERY Collaborative Group . Dexamethasone in Hospitalized Patients with Covid‐19. N Engl J Med. 2021;384(8):693‐704. 10.1056/nejmoa2021436 - DOI - PMC - PubMed

Publication types