Page 34 - JCTR-11-1

Journal of Clinical and
Translational Research Dexamethasone in critical COVID-19

1. Introduction intensive care unit (ICU), serving as a support tool for
clinical decision-making.
Coronavirus disease-2019 (COVID-19) is a severe acute
respiratory syndrome caused by severe acute respiratory 2. Methodology
syndrome coronavirus 2 (SARS-CoV-2), first identified
in Wuhan, China, in December 2019. On March 11, This research conducted a cross-sectional study on patients
2020, the World Health Organization (WHO) declared admitted to the COVID-19 ICU of a reference hospital
1
it a pandemic. The disease manifestation in patients in Salvador, Bahia, from November 2020 to March 2021.
can range from asymptomatic cases to severe respiratory Blood samples were collected in EDTA tubes during their
compromise requiring hospitalization, with intensive care ICU stay after the first and subsequent administrations of
and mechanical ventilation support being essential in dexamethasone to evaluate their laboratory profiles.
critical cases. 2 2.1. Inclusion criteria
Early diagnosis and analysis of laboratory parameters Adult patients aged 18 years or older with confirmed SARS-
are essential for diagnosing and predicting the disease, CoV-2 infection who consented to participate in the study
preventing its dissemination, controlling its progression by signing an informed consent form. All patients were
more effectively, monitoring patient’s outcomes, and treated with dexamethasone, the only pharmacotherapy
performing therapeutic monitoring. The main laboratory with proven efficacy during the study period.
findings in patients with COVID-19 include changes in
C-reactive protein (CRP), leukocyte counts, albumin, 2.2. Exclusion criteria
hemoglobin, alanine aminotransferase (ALT), aspartate Patients under 18 years of age or those who declined to
aminotransferase (AST), and lactate dehydrogenase participate in the study were excluded from the study.
(LDH). The main routine tests requested for COVID- Demographic data were obtained from electronic medical
3
19 patients include blood counts, coagulation and records at the time of admission.
fibrinolysis cascades (prothrombin time [PT], activated
partial thromboplastic time [aPTT], and D-dimers), and The researchers conducted an initial descriptive
inflammatory markers (CRP, ferritin, and procalcitonin). analysis of the 22 study participants. For quantitative
In addition, tests analyzing biochemical factors that variables, results are presented with a 95% confidence
represent the activities of vital organs such as the liver, interval (CI) and grouped distributions by class, showing
kidneys, and heart are crucial, given the virus-induced both the observed counts and equivalent percentages.
impairments. 4 Relative risk (RR) analyses were applied to assess the
The hematological studies among COVID-19 patients increased mortality risk. Statistical significance was set
noted common changes including a decrease in at α = 0.05, with two-tailed P-values of <0.05 considered
lymphocytes, mild thrombocytopenia, increased PT, significant.
and prolonged aPTT. Elevated D-dimer levels further The Research Ethics Committee of Hospital Santa
indicate coagulopathy and serve as an essential marker of Izabel - Santa Casa de Misericórdia da Bahia/Prof.
disease progression. In addition, increases in erythrocyte Dr. Celso Figueirôa reviewed and approved this study.
sedimentation rate, CRP, and procalcitonin are frequently Informed consent was obtained from patients or their
observed. Ferritin rises during the acute inflammation guardians through email, in person, or through Google
stage and even after viral infections, particularly in dialysis Forms, allowing medical record data and biological
patients, making it a practical screening tool for assessing samples to be used for research purposes.
COVID-19 conditions. Regarding disease prognosis, a
5,6
recent report recommends monitoring biomarkers such 3. Results
7
as LDH, AST, ALT, total bilirubin, creatinine, cardiac The clinical and laboratory features, as well as complications
troponin, and serum albumin levels due to their association of COVID-19 patients, are reviewed in Table 1. The study
with the worsening clinical status of patients. Other studies included 22 patients, with 11 men and 11 women, having
have highlighted age, viral load, lung injury score, and a mean weight and age of 79.32 kg and 62.14 years,
blood biochemistry indices such as hypoalbuminemia, respectively. The average length of stay in the ICU was
elevated D-dimer, CRP, LDH, and lymphopenia are 14.4 days, with 86.4% patients intubated (19/22). All
associated with the severity of COVID-19. 8 patients who died were on mechanical ventilation. Table 1
Given the current scenario, this study aims to describe presents the laboratory alterations studied. Only creatinine
the clinical and laboratory characteristics of critically ill had a relative risk (RR 6.13; P < 0.002) considered
COVID-19 patients treated with dexamethasone in an significant.

Volume 11 Issue 1 (2025) 28 doi: 10.36922/jctr.24.00036