In Patients Admitted to ICU with SARS-CoV-2 Infection, is Dexamethasone Superior to Standard Care in Improving Mortality? A Systematic Review of Evidence to Date
Keywords:COVID-19, Dexamethasone, Intensive care unit
Introduction: Dexamethasone is a potent broad-spectrum corticosteroid that decreases the transcription of pro-inflammatory cytokines, whilst simultaneously increasing the transcription of anti-inflammatory cytokines. The cytokine storm that is central to the pathogenesis of acute respiratory distress syndrome (ARDS) and multi-organ failure is seen in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related deaths. The objective of the study was to systematically review the use of dexamethasone for COVID-19 in adult ICU patients and to ascertain if there was a survival benefit compared to standard care (SC) alone.
Methods: A literature search of two databases, EMBASE and PubMed, was conducted using the terms “COVID-19”, “Dexamethasone”, and “ICU”. The search was limited to studies published in the English language. The PRISMA guidelines were used to guide our search methodology.
Results: The database search identified 59 articles. Of these, two duplicates were discarded, and 57 studies were screened. 54 of these publications were deemed irrelevant based on the inclusion and exclusion criteria. Three were forwarded for full text review and met inclusion and exclusion criteria on full-text review. All three were deemed eligible. The selected studies consisted of two randomised controlled trials (RCTs) and one case series report. The results from the three papers were unanimous in their conclusion that dexamethasone was superior to SC in the treatment of patients admitted to ICU with SARS-CoV-2. There was also a shorter duration of hospitalisation seen in the patient group treated with dexamethasone.
Conclusion: Our systematic review found that dexamethasone was superior to SC in patients admitted to the ICU with SARS-CoV-2 infection. However, administration of dexamethasone to patients not on respiratory support resulted in a higher incidence of death, compared to SC.
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