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DOI:    [Accepted]
The effect of the timing of dexamethasone administration in patients with COVID-19 pneumonia
Hyun Woo Lee, M.D., Jimyung Park, M.D., Jung-Kyu Lee, M.D., Tae Yeon Park, M.D., Eun Young Heo, M.D.
Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
Correspondence:  Eun Young Heo, Tel: +82-2-870-3207, Fax: +82-2-831-0714, 
Received: 18 January 2021   • Revised: 9 March 2021   • Accepted: 27 April 2021
Despite the proven benefits of dexamethasone in hospitalized COVID-19 patients, the optimum time for the administration of dexamethasone is unknown. We investigated the progression of COVID-19 pneumonia based on the timing of dexamethasone administration.
A single-center, retrospective cohort study based on medical record reviews was conducted between June 10 and September 21, 2020. We compared the risk of severe COVID-19, defined as the use of a high-flow nasal cannula or a mechanical ventilator, between groups that received dexamethasone either within 24 hours of hypoxemia (early dexamethasone group) or 24 hours after hypoxemia (late dexamethasone group). Hypoxemia was defined as room-air SpO2 <90%.
Among 59 patients treated with dexamethasone for COVID-19 pneumonia, 30 were in the early dexamethasone group and 29 were in the late dexamethasone group. There was no significant difference in baseline characteristics, the time interval from symptom onset to diagnosis or hospitalization, or the use of antiviral or antibacterial agents between the two groups. The early dexamethasone group showed a significantly lower rate of severe COVID-19 compared to the control group (75.9% vs 40.0%, P-value=0.012). Further, the early dexamethasone group showed a significantly shorter total duration of oxygen supplementation (10.45 d vs. 21.61 d, P-value=0.003) and length of stay in the hospital (19.76 d vs. 27.21 d, P-value=0.013). However, extracorporeal membrane oxygenation and in-hospital mortality rates were not significantly different between the two groups.
Early administration of dexamethasone may prevent the progression of COVID-19 to a severe disease, without increased mortality.
Key Words: Coronavirus disease 2019 (COVID-19), Pneumonia, Inhalation Therapy, Oxygen, Dexamethasone, Respiratory Failure

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