Dexamethasone Improves Cardiovascular Outcomes in Critically Ill COVID-19, a Real World Scenario Multicenter Analysis

Abstract

Background: Severe COVID-19 pneumonia requiring intensive care treatment remains a clinical challenge to date. Dexamethasone was reported as a promising treatment option, leading to a reduction of mortality rates in severe COVID-19 disease. However, the effect of dexamethasone treatment on cardiac injury and pulmonary embolism remains largely elusive.

Methods: In total 178 critically ill COVID-19 patients requiring intensive care treatment and mechanical ventilation were recruited in three European medical centres and included in the present retrospective study. One hundred thirteen patients (63.5%) were treated with dexamethasone for a median duration of 10 days (IQR 9-10). Sixty five patients (36.5%) constituted the non-dexamethasone control group.

Results: While peak inflammatory markers were reduced by dexamethasone treatment, the therapy also led to a significant reduction in peak troponin levels (231 vs. 700% indicated as relative to cut off value, p = 0.001). Similar, dexamethasone resulted in significantly decreased peak D-Dimer levels (2.16 mg/l vs. 6.14 mg/l, p = 0.002) reflected by a significant reduction in pulmonary embolism rate (4.4 vs. 20.0%, p = 0.001). The antithrombotic effect of dexamethasone treatment was also evident in the presence of therapeutic anticoagulation (pulmonary embolism rate: 6 vs. 34.4%, p < 0.001). Of note, no significant changes in baseline characteristics were observed between the dexamethasone and non-dexamethasone group.

Conclusion: In severe COVID-19, anti-inflammatory effects of dexamethasone treatment seem to be associated with a significant reduction in myocardial injury. Similar, a significant decrease in pulmonary embolism, independent of anticoagulation, was evident, emphasizing the beneficial effect of dexamethasone treatment in severe COVID-19.

Keywords: COVID-19; anticoagulation; cardiac injury; dexamethasone; pulmonary embolism.

Figure 1

(A) plasma levels of high sensitivity troponine normalized to %ULN in patients treated with dexamethasone vs. controls, (B) plasma levels of D-dimer in patients treated with dexamethasone vs. controls. *indicates a p of <0.05; **a p of <0.01 and *** a p of <0.001; n.s., not significant. hs, high sensitivity; ULN, upper limit of norm.

Figure 2

Incidence of pulmonary embolism in patients treated with dexamethasone vs. controls. * indicates a p of <0.05; ** a p of <0.01 and *** a p of <0.001; n.s., not significant.

Figure 3

Incidence of pulmonary embolism despite therapeutic anticoagulation in patients treated with dexamethasone vs. controls. *indicates a p of <0.05; ** a p of <0.01 and *** a p of <0.001, n.s., not significant. AC, anticoagulation.