The aim of our work was to retrospectively review the efficacy of high-dose dexamethasone in patients with SARS-CoV-2 pneumonia-related ARDS admitted to a COVID-19 hub in Lombardy (Italy) during the first wave of the disease.įrom March 4th to April 1st, 2020, all adult patients (≥ 18 years) with confirmed COVID-19 pneumonia (laboratory real-time-polymerase chain reaction SARS-CoV-2 positivity and/or chest computed tomography scan suggestive for interstitial pneumonia) admitted to the High-Intensity Care of the Internal Medicine Department (Ospedale di Circolo – Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy) were included in the present retrospective study. Few weeks before the outbreak of COVID-19 pandemic, a multicenter Spanish study demonstrated that early administration of high-dose dexamethasone in patients with established moderate-to-severe ARDS reduced the duration of mechanical ventilation and overall mortality. A reduced 28-day mortality was found in the dexamethasone group compared with the usual care group, with the largest benefit among those patients receiving invasive mechanical ventilation or any oxygen support at the time of randomization. usual care alone in patients with SARS-CoV-2 infection.
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The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial has investigated the role of low-dose dexamethasone (6 mg daily up to 10 days) on top of usual care vs. Numerous collaborative trials investigated the effectiveness of remdesivir and some immunomodulating agents with contrasting or neutral results. All these events may then culminate and/or sustain immunothrombosis, that is responsible for poor outcomes. high levels of interleukin (IL)-6 and other cytokines like IL-1, tumor necrosis factor (TNF)-α, IL-18, and granulocyte–macrophage colony-stimulating factor (GM-CSF). The second step consists in the activation of anti-viral mechanisms, that may trigger an exaggerated immune response characterized by a cytokine storm, i.e. hypothesized that, in the first stages, the virus induces a temporary immunodeficiency status (i.e., interferon suppression and lymphopenia).
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Although most patients experience mild symptoms, a small proportion of them develops severe, viral interstitial pneumonia with increasing hypoxia that can cause acute respiratory distress syndrome (ARDS), multiorgan failure, and death. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the pandemic of coronavirus disease 2019 (COVID-19). These data support the importance of randomized clinical trials with high-dose dexamethasone in COVID-19 patients. CVD was found to increase the risk of the composite outcome. In hospitalized patients with COVID-19-related ARDS, high-dose dexamethasone rapidly improves the clinical status and decreases inflammatory biomarkers. CVD was found to increase the risk of the composite outcome (RR 7.64, 95% CI 1.24–47.06, p = 0.028). A concomitant decrease in C-reactive protein and ferritin levels was found (132.25 mg/L vs.
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Following dexamethasone treatment, a significant improvement in PaO 2/FiO 2 (277.41 mmHg vs. Hypertension and cardiovascular disease (CVD) were prevalent. Most patients were males (62%) with a mean age of 69 years. Those who after at least 7 days from symptom onset presented a worsening of the respiratory function or of inflammatory biomarkers were started on intravenous high-dose dexamethasone (20 mg daily for 5 days, followed by 10 mg daily for 5 days).
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From March 4th to April 1st 2020, 98 patients with COVID-19 pneumonia were included. We retrospectively analyzed the efficacy of high-dose dexamethasone in patients with COVID-19-related ARDS and evaluated factors affecting the composite outcome (death or invasive mechanical ventilation). Low-dose dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS).