High-Dose Dexamethasone May Be Harmful for Patients With COVID-19

The risk for mortality was similar between high- vs standard-dose dexamethasone in patients with COVID-19, but higher doses increased the length of ICU stay.

Patients hospitalized with COVID-19 receiving supplemental oxygen had similar mortality outcomes with high- vs standard-dose dexamethasone, but evidence suggests higher dexamethasone doses may be associated with adverse outcomes. These study results were presented at IDWeek 2022, held from October 19 to 23, in Washington, DC.

Anti-inflammatory agents, such as dexamethasone, are standard treatment for COVID-19 infection. Current evidence indicates that a 6-mg dose of dexamethasone daily is effective for improving COVID-19 outcomes among patients receiving supplemental oxygen. However, patients are often prescribed higher doses despite a lack of evidence justifying this clinical decision.

To evaluate whether higher doses of dexamethasone may be more effective, researchers conducted a multisite, retrospective, observational study. Included patients were those who were hospitalized with COVID-19 infection and receiving supplemental between June 2020 and January 2022. Patients who received high-dose dexamethasone (>10 mg daily; n=159) were matched in a 3:1 fashion with those who received standard-dose dexamethasone (£6 mg daily; n=53); the researchers compared outcomes between the groups.

No significant differences in the rate of mortality, the number of patients with blood glucose concentrations above 200 mg/dL, the rate of nosocomial infections, hospitalization, or the number of ventilator-free days (all P >.05) were observed on the basis of dexamethasone dosing.

This study supports the use of SD DEX in ventilated COVID-19 patients

Similar results were observed after adjustment for potential confounding factors, with no significant differences observed between the 2 patient groups in regard to the risk for mortality (adjusted odds ratio [aOR], 1.45; 95% CI, 0.66-3.20).

In the adjusted analysis, however, receipt of high-dose dexamethasone was associated with increases in daily blood glucose concentrations (P =.003) and length of intensive care unit stay (P =.019) compared with receipt of standard-dose dexamethasone.

This study was limited by its small sample size.

“This study supports the use of SD DEX [standard-dose dexamethasone] in ventilated COVID-19 patients,” the researchers concluded.


Kale-Pradhan P, Pacitto R, Krumm L, et al. Effect of high-dose versus standard-dose dexamethasone on mortality among mechanically ventilated COVID-19 patients. Presented at: IDWeek 2022; October 19-23; Washington, DC. Poster 1124.