Outcome of hypoxic COVID-19 patients treated with dexamethasone-based treatment protocol in a designated COVID center

Authors

  • Adarsh M. B. Department of General Medicine, Government Medical College, Kasaragod, Kerala, India http://orcid.org/0000-0001-8091-1952
  • Anitha Abraham Department of Community Medicine, Government Medical College, Kasaragod, Kerala, India
  • Kavitha P. Department of Anaesthesia, Government Medical College, Kasaragod, Kerala, India
  • Meera M. Nandakumar Department of ENT, Government Medical College, Kasaragod, Kerala, India
  • Raman Swathy Vaman Department of General Medicine, Government Medical College, Kasaragod, Kerala, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20211770

Keywords:

COVID-19, Dexamethasone, Hydroxychloroquine, Hypoxia, Pneumonia

Abstract

Background: Managing severe COVID-19 is a difficult situation in resource limited settings. With the inclusion of steroid based treatment guidelines, this can be made feasible in such settings.

Methods: This was a hospital record based retrospective cohort study done at a designated COVID hospital. Data of all patients who were 18 years and above, hypoxic and required initiation of dexamethasone-based protocol were analysed. Hypoxia was defined as a finger pulse oximeter value less than 95%. The primary outcome was the percentage of patients who required a referral to the higher centre or died in hospital.

Results: 109 patients with hypoxia with a mean age of 55.2±13.5 years and a median symptom duration of 4 days were analyzed. Seventy-eight (71%) patients were male and 81 (74.3%) had other comorbid illnesses. Of the 109 patients, 5 (4.6%) patients died in hospital, 22 (20.2%) patients were referred to higher center for further management and 82 (75.2%) patients could be treated and discharged. Those who were referred or died had lower SpO2, reduced time to initiation of protocol, more severe pneumonia, lower absolute lymphocyte count and lower platelet count. New onset diabetes was detected in 20 (18.3%) patients.

Conclusions: Detection of hypoxia early and initiation of dexamethasone-based treatment protocol with timely referral of worsening patients can help to improve outcome in COVID-19 patients. This model can be effectively constructed in limited resource settings and can be of much help to the struggling health infrastructure.

Author Biographies

Adarsh M. B., Department of General Medicine, Government Medical College, Kasaragod, Kerala, India

Assistant professor, General medicine

Anitha Abraham, Department of Community Medicine, Government Medical College, Kasaragod, Kerala, India

Assistant professor, Community Medicine

Kavitha P., Department of Anaesthesia, Government Medical College, Kasaragod, Kerala, India

Assistant professor, Anaesthesia

Meera M. Nandakumar, Department of ENT, Government Medical College, Kasaragod, Kerala, India

Senior resident, ENT

Raman Swathy Vaman, Department of General Medicine, Government Medical College, Kasaragod, Kerala, India

Superintendent

References

COVID-19 and the least developed countries. Department of Economic and Social Affairs. Available at https:// www. un.org/ development/ desa/dpad/publication/un-desa-policy-brief-66-covid-19-and-the-least-developed-countries/. Accessed on 10 December 2020.

Radha D, Kumaran JAB, Nair MTR. Role of local self-governments in control of COVID-19 in Kerala: an exploratory study. Int J Community Med Public Health. 2020;7(12):5027.

Pan H, Peto R, Karim QA, Alejandria M, Restrepo AM. WHO Solidarity trial consortium repurposed antiviral drugs for COVID-19 interim WHO SOLIDARITY trial results. Available at http://medrxiv.org/lookup/doi/10.1101/2020.10.15.20209817. Accessed on 12 January 2021.

Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC. Remdesivir for the Treatment of Covid-19 final report. N Engl J Med. 2020;383(19):1813-26.

The Recovery Collaborative Group. Effect of hydroxychloroquine in hospitalized patients with Covid-19. N Engl J Med. 2020;383(21):2030-40.

The Recovery Collaborative Group. Dexamethasone in hospitalized patients with covid-19 preliminary report. N Engl J Med. 2020;7:20-21.

Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA. 2020;324(13):1307.

WHO rapid evidence appraisal for COVID-19 Therapies (REACT) Working Group, Sterne JAC, Murthy S, Diaz JV, Slutsky AS, Villar J, et al. Association between administration of systemic corticosteroids and mortality among critically Ill patients with COVID-19: a meta-analysis. JAMA. 2020;324(13):1330-41.

Information on COVID-19 treatment, prevention and research. Covid-19 treatment guidelines. Available at https://www.Covid19treatmentguide lines.nih.gov/. Accessed on 10 January 2021.

Organization WH. Corticosteroids for COVID-19: living guidance. Available at https://apps.who.int/iris/handle/10665/334125. Accessed on 12 January 2021.

COVID-19 Guideline, Part 1: Treatment and Management. Available at https:// www. idsociety. org/practice-guideline/covid-19-guideline-treatment-and-management/ Accessed on 12 September 2020.

COVID-19-Rx-Guidelines-15th-August-2020.pdf. Available at https://dhs.kerala.gov.in/wp-content/uploads/2020/08/COVID-19-Rx-Guidelines-15th-August-2020.pdf. Accessed on Accessed on 12 September 2020.

COVID-19- Interim- Treatment- Guidelines-Kerala. pdf. Available at https:// dhs. kerala.gov.in/wp-content/uploads/2020/03/COVID-19-Interim-Treatment-Guidelines-Kerala.pdf. Accessed on 12 September 2020.

Feng X, Li P, Ma L, Liang H, Lei J, Li W, et al. Clinical characteristics and short-term outcomes of severe patients with COVID-19 in Wuhan, China. Front Med. 2020;7:491.

Liu J, Zhang S, Wu Z, Shang Y, Dong X, Li G, et al. Clinical outcomes of COVID-19 in Wuhan, China: a large cohort study. Ann Intensive Care. 2020;10(1):99.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054-62.

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934.

Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID ‐19. Diabetes Metab Res Rev. 2020;36(7):1002-3.

GoK Dashboard. Official Kerala COVID-19 Statistics. Available at https:// dashboard. kerala. gov.in/deaths.php. Accessed on 12 December 2020.

Downloads

Published

2021-04-27

How to Cite

B., A. M., Abraham, A., P., K., Nandakumar, M. M., & Vaman, R. S. (2021). Outcome of hypoxic COVID-19 patients treated with dexamethasone-based treatment protocol in a designated COVID center. International Journal Of Community Medicine And Public Health, 8(5), 2441–2446. https://doi.org/10.18203/2394-6040.ijcmph20211770

Issue

Section

Original Research Articles