(094) High dose dexamethasone for COVID-19 not common in a large US hospital network

Publication Number: 431

Background: The UK Recovery trial reported increased 28-day mortality among patients hospitalized with COVID-19 allocated to higher dose dexamethasone compared to usual care (including standard dose dexamethasone) who, at randomization, required either no oxygen or simple oxygen only. Little is known on dexamethasone dosing for COVID-19 management in US inpatient facilities.

Objectives: To examine dexamethasone use and dose by respiratory support categories, in hospitalizations with a COVID-19 diagnosis, between April 2020 and October 2022, in a large US hospital network.

Methods: A retrospective cohort study was conducted using inpatient electronic health records (EHR), including semi structured nursing documentation, from 142 HCA Healthcare hospitals. Hospitalizations with a COVID-19 diagnosis where oral or injectable dexamethasone was administered, were identified. Median daily dexamethasone dose, categorized as standard (≤6mg daily), moderately high (>6-≤10 mg daily), high (>10-≤20mg daily), and very high (>20mg daily), was calculated and stratified by respiratory support requirements from nursing documentation—no oxygen, simple oxygen, non-simple oxygen, and invasive mechanical ventilation or extracorporeal membrane oxygenation (IMV/ECMO)—between admission and dexamethasone administration date.

Results: There were 305,965 hospitalizations with a COVID-19 diagnosis between April 1, 2020, and October 31, 2022. Of these, 188,467 (61.6%) had dexamethasone administered, and median time to administration was 0 [interquartile range (IQR), 0-1] days and median duration of use was 5 (IQR, 3-9) days. Almost 23% and 70.4% required no oxygen or simple oxygen only at the time of dexamethasone administration, respectively. Median daily dexamethasone dose was 6 (IQR, 6-8) mg. Standard daily doses of dexamethasone were largely administered (79.1%) irrespective of level of respiratory support required. A total of 13,571 (7.8%) hospitalizations requiring either no oxygen or simple oxygen until the time of dexamethasone administration received high or very high daily doses.

Conclusions: Dexamethasone was mostly used at standard daily doses for COVID-19 in the US inpatient facilities examined, which provides reassurance that potential harmful higher doses are not common. However, higher daily doses were seen in some hospitalizations requiring no oxygen or simple oxygen alone at the time of treatment initiation. Given potential harm from higher doses in these groups, restricting dexamethasone to standard daily doses of ≤6mg should be considered.

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