Wagley Abdullah, Fatima Samar, Awan Safia, Zakaria Maheen, Arshad Aleena, Khalid Farah, Nasir Noreen, Aqeel Masooma, Nasir Nosheen
Aga Khan University Medical College, Karachi, Pakistan.
Department of Medicine, Aga Khan University, Karachi, Pakistan.
Ther Adv Infect Dis. 2025 Apr 22;12:20499361251328824. doi: 10.1177/20499361251328824. eCollection 2025 Jan-Dec.
BACKGROUND: Studies comparing the effectiveness of dexamethasone versus methylprednisolone for treating severe-to-critical COVID-19 have produced conflicting results. This study aimed to evaluate the impact of dexamethasone compared with methylprednisolone on in-hospital mortality among patients with severe or critical COVID-19. OBJECTIVES: The objective of this study was to assess the effectiveness of dexamethasone in comparison to methylprednisolone in reducing in-hospital mortality in patients suffering from severe-to-critical COVID-19 pneumonia. DESIGN: This was a retrospective observational study conducted at a tertiary care academic medical center. METHODS: Clinical data from 706 hospitalized patients with severe or critical COVID-19 in Karachi, Pakistan, were reviewed. Of these patients, 217 received either oral or intravenous dexamethasone, and 393 were treated with methylprednisolone. The primary outcome was in-hospital mortality, while secondary outcomes included the length of hospitalization and the need for mechanical ventilation. RESULTS: The methylprednisolone group had a male predominance (74% vs 54%; < 0.001). However, there was no significant difference in median age between the dexamethasone group (55 years) and the methylprednisolone group (57 years) ( = 0.09). Mortality was significantly higher in the methylprednisolone group compared to the dexamethasone group (13.7% vs 3.2%, < 0.001). Multivariable analysis showed that dexamethasone was associated with lower in-hospital mortality (adjusted odds ratio (aOR): 0.24; 95% CI: 0.09-0.62; = 0.003). Furthermore, patients in the dexamethasone group had a shorter length of hospital stay (aOR: 0.87 (95% CI: 0.82-0.92)) compared to the methylprednisolone group. A higher proportion of patients required invasive mechanical ventilation in the methylprednisolone group compared to the dexamethasone group (13.7% vs 3.2%; < 0.001). CONCLUSION: Dexamethasone was associated with lower mortality and a reduced length of hospital stay and a lower proportion of patients required mechanical ventilation compared to methylprednisolone in patients with severe-to-critical COVID-19.
背景：比较地塞米松与甲泼尼龙治疗重型至危重型新型冠状病毒肺炎（COVID-19）有效性的研究结果相互矛盾。本研究旨在评估地塞米松与甲泼尼龙相比，对重型或危重型COVID-19患者院内死亡率的影响。 目的：本研究的目的是评估地塞米松与甲泼尼龙相比，在降低重型至危重型COVID-19肺炎患者院内死亡率方面的有效性。 设计：这是一项在三级医疗学术医学中心进行的回顾性观察研究。 方法：回顾了巴基斯坦卡拉奇706例住院的重型或危重型COVID-19患者的临床资料。其中，217例患者接受了口服或静脉注射地塞米松治疗，393例患者接受了甲泼尼龙治疗。主要结局是院内死亡率，次要结局包括住院时间和机械通气需求。 结果：甲泼尼龙组男性占优势（74%对54%；P<0.001）。然而，地塞米松组（55岁）和甲泼尼龙组（57岁）的中位年龄无显著差异（P=0.09）。与地塞米松组相比，甲泼尼龙组的死亡率显著更高（13.7%对3.2%，P<0.001）。多变量分析显示，地塞米松与较低的院内死亡率相关（调整后的优势比（aOR）：0.24；95%置信区间：0.09-0.62；P=0.003）。此外，与甲泼尼龙组相比，地塞米松组患者的住院时间更短（aOR：0.87（95%置信区间：0.82-0.92））。与地塞米松组相比，甲泼尼龙组需要有创机械通气的患者比例更高（13.7%对3.2%；P<0.001）。 结论：在重型至危重型COVID-19患者中，与甲泼尼龙相比，地塞米松与较低的死亡率、缩短的住院时间以及较低的机械通气患者比例相关。
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