The effectiveness of dexamethasone on the prognosis of dialysis patients with severe COVID-19

Toçoglu, Aysel; Dheir, Hamad; Demirci, Taner; Kurt, Rumeysa; Salihi, Salih; Yaylaci, Selçuk; Çakar, Gözde Çakırsoy; Toptan, Hande; Karabay, Oguz; Sipahi, Savas

doi:10.1590/1806-9282.20210600

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Original Article • Rev. Assoc. Med. Bras. 67 (9) • Sept 2021 • https://doi.org/10.1590/1806-9282.20210600 copy

The effectiveness of dexamethasone on the prognosis of dialysis patients with severe COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to investigate the effectiveness of dexamethasone in dialysis patients with COVID-19 and whether it predicts mortality.

METHODS:

This is a comparative cross-sectional study of 113 consecutive patients with COVID-19 with severe pneumonia signs. The patients were divided into two groups according to the use of dexamethasone treatment: group 1 (n=45) included patients who were treated with dexamethasone and group 2 (n=68) who did not receive dexamethasone.

RESULTS:

The mean age of both groups was 67.0±10.6 and 67.2±13.0 years, respectively (p=0.947). With respect to demographic and laboratory findings, there were no significant differences between the two groups (p>0.05). The hospitalization time of patients in group 1 was longer than that in group 2 (11 [7–17] days vs. 8 [5.3–14] days, p=0.093]. The 28-day survival rate was 54.2% in the group receiving dexamethasone treatment and 79.5% in the group not receiving dexamethasone treatment (p=0.440).

CONCLUSION:

Dexamethasone did not reduce mortality rates and the requirement for intensive care unit in dialysis patients with COVID-19. Larger prospective randomized clinical trials are required to associate personalized medicine with the corticosteroid treatment to select suitable patients who are more likely to show a benefit.

KEYWORDS:
Chronic kidney disease; COVID-19; Dexamethasone; Dialysis; Mortality

		Group 1 (n=45)	Group 2 (n=68)	p-value
Renal replacement therapy, n (%)
	Hemodialysis	40 (88.9)	65 (95.6)	0.174
	Peritoneal dialysis	5 (11.1)	3 (4.4)	0.174
Age, years		67.0±10.6 (22–85)	67.2±13.0 (25–89)	0.947
Gender
	Female/Male (%)	25/20 (55.6/44.4)	28/40 (41.2/58.8)	0.134
Presenting symptom, n (%)
	Fever	28 (62.2)	44 (64.7)	0.788
	Cough	13 (28.9)	32 (47.1)	0.053
	Dyspnea	26 (57.8)	31 (45.6)	0.205
	Weakness	28 (62.2)	29 (42.6)	0.042
	Diarrhea	0	3 (4.4)	0.153
	Nausea and vomiting	4 (8.9)	6 (8.8)	0.990
	Anosmia	1 (2.2)	0	0.398
	Headache	0	3 (4.5)	0.272
Chronic diseases, n (%)
	Diabetes	21 (46.7)	34 (50.0)	0.729
	Hypertension	39 (86.7)	59 (86.8)	0.988
	ASCVD	21 (46.7)	24 (35.3)	0.227
	COPD	3 (6.7)	8 (11.8)	0.371
	Malignancy	4 (8.9)	4 (5.9)	0.542
The onset of symptoms, median (IQR) days		3 (1.5– -8)	2 (1–5)	0.082
Hospitalization time, median (IQR) days		11 (7–17)	8 (5.3–14)	0.093

		Group 1 (n=45)	Group 2 (n=68)	p-value
Creatinine, mg/dL		6.0±2.7	5.9±2.6	0.765
White blood cell count, 10³3 Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, et al. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrol Dial Transplant. 2020;35(12):2083-95. https://doi.org/10.1093/ndt/gfaa271 https://doi.org/10.1093/ndt/gfaa271... /mm³3 Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, et al. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrol Dial Transplant. 2020;35(12):2083-95. https://doi.org/10.1093/ndt/gfaa271 https://doi.org/10.1093/ndt/gfaa271...		6.80 (4.82–8.85)	5.6 (4.45–7.59)	0.109
Absolute lymphocyte count, 10³3 Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, et al. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrol Dial Transplant. 2020;35(12):2083-95. https://doi.org/10.1093/ndt/gfaa271 https://doi.org/10.1093/ndt/gfaa271... /mm³3 Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, et al. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrol Dial Transplant. 2020;35(12):2083-95. https://doi.org/10.1093/ndt/gfaa271 https://doi.org/10.1093/ndt/gfaa271...		0.74 (0.48–1.14)	0.80 (0.47–1.07)	0.893
Neutrophil-to-lymphocyte ratio		6.57 (3.42–14.70)	5.86 (3.52–10.60)	0.395
Platelet count, 10³3 Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, et al. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrol Dial Transplant. 2020;35(12):2083-95. https://doi.org/10.1093/ndt/gfaa271 https://doi.org/10.1093/ndt/gfaa271... /mm³3 Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, et al. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrol Dial Transplant. 2020;35(12):2083-95. https://doi.org/10.1093/ndt/gfaa271 https://doi.org/10.1093/ndt/gfaa271...		170±69	154±75	0.259
C-reactive protein, mg/L		113.9 (43.4–218.6)	81.6 (30.1–158.1)	0.242
Procalcitonin, ng/mL		1.17 (0.49–4.32)	1.06 (0.45–5.51)	0.826
Alanine aminotransferase, IU/L		14.0 (9.5–21.5)	14.5 (9.3–27.0)	0.647
Aspartate aminotransferase, IU/L		33.0 (22.0–43.0)	26.0 (18.0–45.0)	0.231
Fibrinojen, mg/dL		465±148	422±112	0.122
d-Dimer, ng/mL		1110 (564–2405)	931 (557–2720)	0.960
Albumin, g/L		3.0±0.5	3.1±0.6	0.519
Ferritin, ng/mL		1702 (761–3187)	1575 (661–3367)	0.946
Lactate, mEq/L		1.77±0.88	1.38±0.48	0.010
Interleukin-6, pg/mL (n=60)		81.6 (41.7–424.0)	72.3 (31.5–300.1)	0.676
Treatment location at admission, n (%)
	Ward	32 (71.1)	61 (89.7)	0.011
	Intensive care unit	13 (28.9)	7 (10.3)	0.011
Recruitment to intensive care unit, n (%)		13 (28.9)	19 (27.9)	0.913
Mechanical ventilation support, n (%)
	No	30 (66.7)	52 (76.5)	0.293
	Noninvasive mechanical ventilator	1 (2.2)	–
	Invasive mechanical ventilator	14 (31.1)	16 (23.5)
Rehospitalization after discharge, n (%)
	No	42 (93.3)	65 (95.6)	0.601
	Yes	3 (6.7)	3 (4.4)	0.601
Mortality, n (%)		25 (55.6)	26 (38.2)	0.070

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[1] *Corresponding author: agurkan@sakarya.edu.tr