Association between early dexamethasone administration and mortality in SARS-CoV-2 infection: A cohort study

Dexamethasone, or equivalent corticosteroids, are recommended for patients with SARS-CoV-2 pneumonia, regardless of respiratory failure status. However, the effects of giving dexamethasone within the first seven days after symptom onset-during the viremic phase-have not been sufficiently studied in clinical trials or observational studies. As a result, the best timing for starting corticosteroids remains uncertain. This study aimed to evaluate the effect of dexamethasone administration within seven days of symptom onset from SARS-CoV-2 infection on mortality and the need for invasive mechanical ventilation among hospitalized patients with severe pneumonia.

This cohort study included hospitalized patients aged 18 years or older with severe SARS-CoV-2 pneumonia. The exposure was dexamethasone use before hospitalization, and the outcome measures included in-hospital mortality and invasive mechanical ventilation. Patients were monitored until discharge or death in the hospital. Logistic regression was used to evaluate the association between pre-hospitalization dexamethasone administration and mortality.

We enrolled 234 patients. The median age was 56 years, and 70.5 % were men. Before hospitalization, dexamethasone was administered to 125 (53 %) patients within the first seven days of symptom onset, which was linked to mortality (OR [95 % CI] 3.58 [1.51-8.48]) and the need for invasive mechanical ventilation (OR [95 % CI] 2.59 [1.46-4.59]), after adjusting for factors such as, sex, Charlson comorbidity index ≥ 3, neutrophil count over 8500 cells/mm^³, and albumin below 3 g/dL.

Administering dexamethasone within the first seven days of SARS-CoV-2 infection may be associated with a higher risk of death in hospitalized patients with severe pneumonia. These findings emphasize the importance of carefully timing corticosteroid treatment in COVID-19 patients.