Association between dexamethasone treatment and the host response in COVID-19 patients admitted to the general ward

Abstract

Dexamethasone improves clinical outcomes in COVID-19 patients requiring supplementary oxygen. We investigated possible mechanisms of action by comparing sixteen plasma host response biomarkers in general ward patients before and after implementation of dexamethasone as standard of care. 48 patients without and 126 patients with dexamethasone treatment were sampled within 48 h of admission. Endothelial cell and coagulation activation biomarkers were comparable. Dexamethasone treatment was associated with lower plasma interleukin (IL)-6 and IL-1 receptor antagonist levels, whilst other inflammation parameters were not affected. These data argue against modification of vascular-procoagulant responses as an early mechanism of action of dexamethasone in COVID-19.

Fig. 1

Biomarkers in hospitalized COVID-19 ward patients stratified according to treatment with dexamethasone prior to sampling. Data are expressed as box-whisker diagrams representing the median and 1.5 IQR as whiskers, and individual data points. Dotted lines indicate median values obtained in 21 age-matched outpatient clinic non-infectious controls. * Indicates BH-corrected P < 0.05. IL: interleukin, IL-1RA: interleukin-1 receptor antagonist, MMP-8: matrix metalloproteinase-8, RAGE: receptor for advanced glycation end-products, TREM-1: triggering receptor expressed on myeloid cells-1, VCAM-1: vascular cell adhesion molecule-1