In a recent study published in the Journal of the American Medical Association Network Open, researchers conducted a nationwide, retrospective, propensity score–weighted cohort study of adult patients hospitalized for at least 48 hours for COVID-19 respiratory illness between July 1, 2020, and October 31, 2021, at a large healthcare network of 156 hospitals in the United States. Data analyses were conducted from March 2022 to February 2023.

The primary objective was to investigate the clinical use of dexamethasone for hospitalized patients with COVID-19 respiratory illness and to explore the heterogeneity of treatment outcomes across different subgroups.

The study involved 80,699 patients who met the eligibility criteria, and the average age of participants was 64 years (ranging from 52-76 years). Among the study population, 37,606 were women (46.6%); 13,230 (16.4%) patients identified as African American, 49,222 (60.9%) as Caucasian, 18,247 (22.6%) as other race, and 20,340 (25.2%) as Hispanic ethnicity. Of these patients, 13,040 (16.2%) did not require supplemental oxygen within 48 hours of admission, 56,368 (69.8%) required supplemental oxygen, 7,618 (9.4%) required noninvasive positive pressure ventilation, and 3,673 (4.6%) required mechanical ventilation (MV) and/or extracorporeal membrane oxygenation (ECMO).

The results revealed that early use of dexamethasone was correlated with decreases in both the risk of in-hospital all-cause mortality and discharge to hospice care among patients receiving supplemental oxygen (adjusted odds ratio 0.92; 95% CI, 0.86-0.98) and those receiving MV and/or ECMO (aOR 0.82; 95% CI, 0.68-0.99).

This association between early use of dexamethasone and diminished risk of all-cause in-hospital mortality and discharge to hospice care was not detected among patients who required no supplemental oxygen and those receiving noninvasive positive pressure ventilation.

In conclusion, the authors wrote, "Early administration of dexamethasone was associated with improved mortality or discharge to hospice in those requiring supplemental oxygen or MV and/or ECMO. Continued exploration of patient subgroups will help inform and individualize therapy for COVID-19. Overall, these results demonstrate that despite the evolution of the COVID-19 pandemic over time, dexamethasone remains beneficial for these hospitalized patients in a clinical practice setting."

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