A study assesses risks of dexamethasone

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A new study assesses the risks of using dexamethasone as a treatment for severe COVID-19. Simon Dawson / Bloomberg for Getty Images
  • Individuals with severe COVID-19 often undergo treatment with a steroid drug called dexamethasone.
  • Researchers have studied whether these people experience severe complications due to the side effects of steroid treatment.
  • Those who received treatment with dexamethasone had a 56% reduced risk of death or ICU acceptance of COVID-19.
  • Metabolic experts conclude that receiving dexamethasone does not increase death or admission in ICU in people with severe COVID-19.

With the emergence of the global SARS-CoV-2 pandemic, physicians and researchers have struggled to find effective therapies for the life-threatening complications of COVID-19. Early clinical experience has suggested that administration of potent steroids improves outcomes in people with COVID-19 that require oxygen or mechanical ventilation.

However, steroids have adverse side effects, including elevated blood glucose levels. In individuals with and without a history of diabetes, this can result in short-term and long-term complications, such as an increased risk of infection or metabolic imbalance.

Researchers published results at the November 2021 Society for Endocrinology meeting after observing a large group of people with COVID-19 receiving treatment with dexamethasone, a steroid that doctors use for. treat patients with lung inflammation.

Dr. Victoria Salem, chief investigator, shared Medical News Today: “Dexamethasone is now standard care in patients hospitalized with [COVID-19] requiring oxygen – based on the RECOVERY test. We looked at over 2,000 patients hospitalized with [COVID-19] in our London hospital and performed a multifaceted analysis of risk factors for death.

“It is already known that diabetes is a risk factor for severe COVID. High blood sugar is also a predictor of poor results. Because dexamethasone raises blood sugar, we feared that dexamethasone may have been a double-edged sword for patients with diabetes, but in fact it proved to be just as effective. “

To understand the effects of dexamethasone, researchers looked at the number of ICU admissions, reduced mortality and steroid-related complications in 2,261 patients admitted to the Imperial College Healthcare National Health Service (NHS) Trust hospitals.

The team divided data from individuals hospitalized with COVID-19 into two groups: wave one and wave two. Wave one consisted of 889 people admitted to the hospital between March and April 2020, when doctors did not routinely prescribe dexamethasone. Wave two consisted of 1,372 individuals admitted between November 2020 and January 2021 who took prescription dexamethasone routinely.

The study found that people were less likely to be admitted to the ICU in wave one (18.8%) compared to 27.6% in wave one. There was also a reduction in mortality in wave two, with a 31.8% reduced risk of death. Additional risk factors for ICU acceptance and reduced mortality included having hypertension, increased frailty, reduced kidney function, and being male.

By Medical News Today, Dr. Salem elaborated:

“She is OK. [d]examination belt was used in 68% of patients in our hospital with a diagnosis of [COVID-19], 35% of whom had diabetes.

[O]In the patients treated with dexamethasone for COVID, 19% developed hyperglycemia (high blood sugar) which required further treatment. [A]and, of this group, 12% were new diagnoses of diabetes – the [r]the remaining patients experienced a worsening of pre-existing diabetes. “

[D]r. Salem explained that this “real world” figure is much higher than the result reported by the original RECOVERY study.

“So, 21 people out of 935 (2%) received dexamethasone for [COVID-19] developed steroid-induced diabetes. “

Dexamethasone treatment reduced the risk of death or acceptance of ICU in study participants by 56%. Dr. Salem explained to Medical News Today:

“Dexamethasone has been independently associated with decreased risk of death / admission in ICU to the same extent in people with [d]diabetes and those without diabetes. “

“Dexamethasone-induced diabetes often resolves when treatment is discontinued. It adds an additional burden related to administration and follow-up but [is] It is worth considering the general advantages in terms of recovery of [COVID-19]. Given the current epidemic of obesity, many of the patients may have already had undiagnosed type 2 diabetes, and this was a wake-up call. “

The home message of the study is that dexamethasone treatment reduced the risk of death and acceptance of ICU. Additionally, patients with diabetes are more likely to develop steroid-induced glucose control complications, but this has not increased mortality rates.

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