AUTHOR=Jirak Peter , van Almsick Vincent , Dimitroulis Dimitrios , Mirna Moritz , Seelmaier Clemens , Shomanova Zornitsa , Wernly Bernhard , Semo Dilvin , Dankl Daniel , Mahringer Magdalena , Lichtenauer Michael , Hoppe Uta C. , Reinecke Holger , Pistulli Rudin , Larbig Robert , Motloch Lukas J. 

TITLE=Dexamethasone Improves Cardiovascular Outcomes in Critically Ill COVID-19, a Real World Scenario Multicenter Analysis

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.808221

DOI=10.3389/fmed.2022.808221

ISSN=2296-858X

ABSTRACT=Background: Severe COVID-19 pneumonia requiring intensive care treatment remains a clinical challenge to date. Dexamethasone was reported as a promising treatment option, leading to a reduction of mortality rates in severe COVID-19 disease. However, the effect of dexamethasone treatment on cardiovascular outcomes including cardiac injury and pulmonary embolism remains largely elusive.
Methods: In total 178 critically ill COVID-19 patients requiring intensive care treatment and mechanical ventilation were recruited in three European medical centres and included in the present retrospective study. 113 patients (63.5%) were treated with dexamethasone for a median duration of 10 days (IQR 9-10). 65 patients (36.5%) constituted the non-dexamethasone control group.
Results: While peak inflammatory markers seemed to be reduced by dexamethasone treatment, the therapy led also to a significant reduction in peak troponin levels (231% vs. 700% indicated as relative to cut off value, p=0.001). Similar, dexamethasone resulted in significantly decreased peak D-Dimer levels (2.16 mg/l vs. 6.14mg/l, p=0.002) reflected by a significant reduction in pulmonary embolism rate (4.4% vs. 20.0%, p=0.001). The antithrombotic effect of dexamethasone treatment was also evident in the presence of therapeutic anticoagulation (pulmonary embolism rate: 6% vs. 34.4%, p<0.001). Of note, no significant changes in baseline characteristics were observed between the dexamethasone and non-dexamethasone group.
Conclusion: In severe COVID-19, antiinflammatory effects of dexamethasone treatment seem to be associated with a significant reduction in myocardial injury. Similar, a significant decrease in pulmonary embolism, independent of anticoagulation, was evident, emphasizing the beneficial effect of dexamethasone treatment on cardiovascular outcomes in severe COVID-19.