Abstract
Abstract only
Introduction:
Prior research has shown that hospital outcomes such as mortality among COVID-19 patients receiving methylprednisolone and dexamethasone differed despite having similar anti-inflammatory effect. In this study, we compared mortality rate among three groups (usual care with no steroids [NS], methylprednisolone [MP], or dexamethasone [DE]) of COVID-19 patients.
Methods:
Data was collected retrospectively from a large healthcare system in the South Florida region. All eligible COVID-19 patients from April 1 to Dec 31, 2020 were included in this study. Propensity scores (PS) was utilized to match patients on their demographics and acuity scores (Age Group, Ethnicity, Gender, APR risk of mortality, and APR severity of illness, etc.). All-cause mortality was compared among the three groups after accounting for demographics, length of stay (hospital and ICU), days on MP or DE, ventilator status, days on ventilator, other medication history (HCQ, Tocilizumab, etc.), pO2, and lab values (hCRP, Ferritin, Glucose, etc.). Multivariate Logistic regression and Survival analysis was utilized for the analysis.
Results:
There were a total of 2445 eligible COVID-19 cases. After PS matching, 292 cases in each group (n = 876) were included in the analysis. There were 42% females and the majority of participants were White Hispanic (81%). The average age (SD) of the PS matched cohort was 64 (17.1) years, and there was a significant difference between LOS among the three groups with MP being the highest (Mean: 12.4; SD: 12.1). All-cause mortalities in the NS, MP, and DE groups were about 6%, 19% and 7% (p < 0.0001) respectively. Logistic regression showed that the odds of mortality among NS (AOR: 1.9, 95% CI: 0.10, 41.8) group were higher, and DE (AOR: 0.15, 95% CI: 0.04, 0.57) group were significantly lower than MP group respectively. Similar results were observed in the survival analysis after accounting for total hospital length of stay. The adjusted hazard ratios suggest that patients who were in the DE group had lower mortality as compared to MP group but, the effect was not significant (HR: 0.70, p < 0.18). In a subgroup survival analysis among patients who were ventilated (n = 69) in the matched cohort, mortality was higher in DE group compared to MP group however the effect was not significant (HR: 1.8, 95% CI: 0.82, 4.0).
Conclusions:
Among hospitalized COVID-19 cases, preliminary results show that patients who received DE had lower mortality as compared to those who received MP. Among COVID-19 patients who require mechanical ventilation, sufficiently dosed MP may lead to a decreased mortality as compared to DE. However more in depth analysis with higher number of patients and better characterization of variables such as dosage of the drugs, are needed to confirm these findings.