Association Between Dexamethasone Treatment After Hospital Discharge for Patients With COVID-19 Infection and Rates of Hospital Readmission and Mortality

• Published in: JAMA network open Vol. 5; no. 3; p. e221455
• Main Authors: Huang, Cheng-Wei, Yu, Albert S, Song, Hubert, Park, Joon S, Wu, Stefanie S, Khang, Vang Kou, Subject, Christopher C, Shen, Ernest
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 01-03-2022
• Subjects: Adult; Aged; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; California; Cohort Studies; Coronaviruses; COVID-19; COVID-19 - drug therapy; COVID-19 - mortality; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; Female; Hospitalization; Humans; Infectious Diseases; Male; Middle Aged; Mortality; Online Only; Original Investigation; Patient Discharge; Patient Readmission; Practice Patterns, Physicians; Retrospective Studies; SARS-CoV-2; Steroids; California
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2022.1455

Current guidelines recommend use of dexamethasone, 6 mg/d, up to 10 days or until discharge for patients hospitalized with COVID-19. Whether patients who received less than 10 days of corticosteroids during hospitalization for COVID-19 benefit from continuing treatment at discharge has not been determined.
To assess whether continuing dexamethasone treatment at discharge is associated with reduced all-cause readmissions or mortality postdischarge.
A retrospective cohort study was conducted at 15 medical centers within Kaiser Permanente Southern California. The population included adults who received less than 10 days of dexamethasone, 6 mg/d, until discharge during hospitalization for COVID-19 and were discharged alive between May 1 and September 30, 2020.
Continued dexamethasone treatment at discharge.
All-cause readmissions or mortality within 14 days from discharge.
A total of 1164 patients with a median age of 55 (IQR, 44-66) years were identified. Most patients were of Hispanic ethnicity (822 [70.6%]) and male (674 [57.9%]) and required oxygen support during hospitalization (1048 [90.0%]). Of the 1164 patients, 692 (59.5%) continued dexamethasone, 6 mg/d, at discharge. A balanced cohort was created using propensity score and inverse probability of treatment weighting. The adjusted odds ratio (OR) for readmissions or mortality within 14 days was 0.87 (95% CI, 0.58-1.30) for patients who continued dexamethasone therapy at discharge compared with those who did not. Similar results were produced by a sensitivity analysis that restricted the treatment group to those who received exactly 10 days of dexamethasone (OR, 0.89; 95% CI, 0.55-1.43) and by subgroup analyses stratified by the duration of dexamethasone treatment as an inpatient (1-3 days: OR, 0.71; 95% CI, 0.43-1.16; 4-9 days: OR, 1.01; 95% CI, 0.48-2.12), oxygen requirement at discharge (room air: OR, 0.91; 95% CI, 0.53-1.59; supplemental oxygen use: OR, 0.76; 95% CI, 0.42-1.37), and disease duration at discharge (≤10 days: OR, 0.81; 95% CI, 0.49-1.33; >10 days: OR, 0.94; 95% CI, 0.48-1.86).
In this cohort study of patients with COVID-19, continuing treatment with dexamethasone, 6 mg/d, at discharge was not associated with a reduction in 14-day all-cause readmission or mortality. This finding suggests that dexamethasone should not be routinely prescribed beyond discharge for individuals with COVID-19.