Dexamethasone doses in patients with COVID-19 and hypoxia: A
systematic review and meta-analysis

J 2024

Dexamethasone doses in patients with COVID-19 and hypoxia: A systematic review and meta-analysis

MUNCH, Marie Warrer, Anders GRANHOLM, Jan MALÁSKA, Jan STAŠEK, Pablo O RODRIGUEZ et. al.

Basic information

Original name

Dexamethasone doses in patients with COVID-19 and hypoxia: A systematic review and meta-analysis

Authors

MUNCH, Marie Warrer, Anders GRANHOLM, Jan MALÁSKA (203 Czech Republic, guarantor, belonging to the institution), Jan STAŠEK (203 Czech Republic, belonging to the institution), Pablo O RODRIGUEZ, Tyler PITRE, Rebecca WILSON, Jelena SAVOVIC, Bram ROCHWERG, Adam SVOBODNÍK (203 Czech Republic, belonging to the institution), Milan KRATOCHVÍL (703 Slovakia, belonging to the institution), Manuel TABOADA, Vivekanand JHA, Bharath Kumar Tirupakuzhi VIJAYARAGHAVAN, Sheila Nainan MYATRA, Balasubramanian VENKATESH, Anders PERNER and Morten Hylander MOLLER

Edition

Acta Anaesthesiologica Scandinavica, HOBOKEN, WILEY, 2024, 0001-5172

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30223 Anaesthesiology

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 2.100 in 2022

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1111/aas.14346

UT WoS

001090806200001

Keywords (in Czech)

corticosteroids; COVID-19; dexamethasone; hypoxia; meta-analysis

Keywords in English

corticosteroids; COVID-19; dexamethasone; hypoxia; meta-analysis

Abstract

V originále

Background: The optimal dose of dexamethasone for severe/critical COVID-19 is uncertain. We compared higher versus standard doses of dexamethasone in adults with COVID-19 and hypoxia.Methods: We searched PubMed and trial registers until 23 June 2023 for randomised clinical trials comparing higher (>6 mg) versus standard doses (6 mg) of dexamethasone in adults with COVID-19 and hypoxia. The primary outcome was mortality at 1 month. Secondary outcomes were mortality closest to 90 days; days alive without life support; and the occurrence of serious adverse events/reactions (SAEs/SARs) closest to 1 month. We assessed the risk of bias using the Cochrane RoB2 tool, risk of random errors using trial sequential analysis, and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: We included eight trials (2478 participants), of which four (1293 participants) had low risk of bias. Higher doses of dexamethasone probably resulted in little to no difference in mortality at 1 month (relative risk [RR] 0.97, 95% CI: 0.79-1.19), mortality closest to Day 90 (RR 1.01, 95% CI: 0.86-1.20), and SAEs/SARs (RR 1.00, 95% CI: 0.97-1.02). Higher doses of dexamethasone probably increased the number of days alive without invasive mechanical ventilation and circulatory support but had no effect on days alive without renal replacement therapy.Conclusions: Based on low to moderate certainty evidence, higher versus standard doses of dexamethasone probably result in little to no difference in mortality, SAEs/SARs, and days alive without renal replacement therapy, but probably increase the number of days alive without invasive mechanical ventilation and circulatory support.

Links

90249, large research infrastructures

Name: CZECRIN IV

Citovat

MUNCH, Marie Warrer, Anders GRANHOLM, Jan MALÁSKA, Jan STAŠEK, Pablo O RODRIGUEZ, Tyler PITRE, Rebecca WILSON, Jelena SAVOVIC, Bram ROCHWERG, Adam SVOBODNÍK, Milan KRATOCHVÍL, Manuel TABOADA, Vivekanand JHA, Bharath Kumar Tirupakuzhi VIJAYARAGHAVAN, Sheila Nainan MYATRA, Balasubramanian VENKATESH, Anders PERNER and Morten Hylander MOLLER. Dexamethasone doses in patients with COVID-19 and hypoxia: A systematic review and meta-analysis. Acta Anaesthesiologica Scandinavica. HOBOKEN: WILEY, 2024, vol. 68, No 2, p. 146-166. ISSN 0001-5172. Available from: https://dx.doi.org/10.1111/aas.14346.

@article{2359479,
   author = {Munch, Marie Warrer and Granholm, Anders and Maláska, Jan and Stašek, Jan and Rodriguez, Pablo O and Pitre, Tyler and Wilson, Rebecca and Savovic, Jelena and Rochwerg, Bram and Svobodník, Adam and Kratochvíl, Milan and Taboada, Manuel and Jha, Vivekanand and Vijayaraghavan, Bharath Kumar Tirupakuzhi and Myatra, Sheila Nainan and Venkatesh, Balasubramanian and Perner, Anders and Moller, Morten Hylander},
   article_location = {HOBOKEN},
   article_number = {2},
   doi = {http://dx.doi.org/10.1111/aas.14346},
   keywords = {corticosteroids; COVID-19; dexamethasone; hypoxia; meta-analysis},
   language = {eng},
   issn = {0001-5172},
   journal = {Acta Anaesthesiologica Scandinavica},
   title = {Dexamethasone doses in patients with COVID-19 and hypoxia: A systematic review and meta-analysis},
   url = {https://onlinelibrary.wiley.com/doi/epdf/10.1111/aas.14346},
   volume = {68},
   year = {2024}
}

TY  - JOUR
ID  - 2359479
AU  - Munch, Marie Warrer - Granholm, Anders - Maláska, Jan - Stašek, Jan - Rodriguez, Pablo O - Pitre, Tyler - Wilson, Rebecca - Savovic, Jelena - Rochwerg, Bram - Svobodník, Adam - Kratochvíl, Milan - Taboada, Manuel - Jha, Vivekanand - Vijayaraghavan, Bharath Kumar Tirupakuzhi - Myatra, Sheila Nainan - Venkatesh, Balasubramanian - Perner, Anders - Moller, Morten Hylander
PY  - 2024
TI  - Dexamethasone doses in patients with COVID-19 and hypoxia: A systematic review and meta-analysis
JF  - Acta Anaesthesiologica Scandinavica
VL  - 68
IS  - 2
SP  - 146-166
EP  - 146-166
PB  - WILEY
SN  - 00015172
KW  - corticosteroids
KW  - COVID-19
KW  - dexamethasone
KW  - hypoxia
KW  - meta-analysis
UR  - https://onlinelibrary.wiley.com/doi/epdf/10.1111/aas.14346
N2  - Background: The optimal dose of dexamethasone for severe/critical COVID-19 is uncertain. We compared higher versus standard doses of dexamethasone in adults with COVID-19 and hypoxia.Methods: We searched PubMed and trial registers until 23 June 2023 for randomised clinical trials comparing higher (>6 mg) versus standard doses (6 mg) of dexamethasone in adults with COVID-19 and hypoxia. The primary outcome was mortality at 1 month. Secondary outcomes were mortality closest to 90 days; days alive without life support; and the occurrence of serious adverse events/reactions (SAEs/SARs) closest to 1 month. We assessed the risk of bias using the Cochrane RoB2 tool, risk of random errors using trial sequential analysis, and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).Results: We included eight trials (2478 participants), of which four (1293 participants) had low risk of bias. Higher doses of dexamethasone probably resulted in little to no difference in mortality at 1 month (relative risk [RR] 0.97, 95% CI: 0.79-1.19), mortality closest to Day 90 (RR 1.01, 95% CI: 0.86-1.20), and SAEs/SARs (RR 1.00, 95% CI: 0.97-1.02). Higher doses of dexamethasone probably increased the number of days alive without invasive mechanical ventilation and circulatory support but had no effect on days alive without renal replacement therapy.Conclusions: Based on low to moderate certainty evidence, higher versus standard doses of dexamethasone probably result in little to no difference in mortality, SAEs/SARs, and days alive without renal replacement therapy, but probably increase the number of days alive without invasive mechanical ventilation and circulatory support.
ER  -

MUNCH, Marie Warrer, Anders GRANHOLM, Jan MALÁSKA, Jan STAŠEK, Pablo O RODRIGUEZ, Tyler PITRE, Rebecca WILSON, Jelena SAVOVIC, Bram ROCHWERG, Adam SVOBODNÍK, Milan KRATOCHVÍL, Manuel TABOADA, Vivekanand JHA, Bharath Kumar Tirupakuzhi VIJAYARAGHAVAN, Sheila Nainan MYATRA, Balasubramanian VENKATESH, Anders PERNER and Morten Hylander MOLLER. Dexamethasone doses in patients with COVID-19 and hypoxia: A systematic review and meta-analysis. \textit{Acta Anaesthesiologica Scandinavica}. HOBOKEN: WILEY, 2024, vol.~68, No~2, p.~146-166. ISSN~0001-5172. Available from: https://dx.doi.org/10.1111/aas.14346.

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