Page 37 - JCTR-11-1

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

of A. baumannii infections in the ICU, which was Dexamethasone has emerged as a key therapeutic
approximately 0.62% during the same period the year agent in the management of critically ill COVID-19
before COVID-19 (P < 0.0001). patients, especially those requiring oxygen support or
Another study conducted in Qom, Iran, examined mechanical ventilation. As a corticosteroid, it helps
19 critically ill patients admitted to ICUs for COVID-19 reduce the excessive inflammatory response caused
treatment. Among these patients, 11 (58%) were male, and by SARS-CoV-2, which can lead to severe lung injury
8 (42%) were female, with an average age of approximately and multiorgan failure. Studies have shown that
67. The mean length of ICU stay was 15 days. Of the dexamethasone can significantly reduce mortality in
19 patients, 18 (95%) died, while only one (5%) survived. these patients by dampening the cytokine storm, a
19
All patients tested positive for bacterial infections, with hyperinflammatory state triggered by the virus. In this
17 (90%) infected by A. baumannii and 2 (10%) infected by study, patients with severe COVID-19, many of whom
Staphylococcus aureus. 14 presented with comorbidities such as hypertension
and diabetes, benefitted from dexamethasone, which
In another study, 83.2% of patients presented with was administered as part of their treatment regimen to
7
lymphocytopenia, 36.2% with thrombocytopenia, and manage severe inflammation. However, its use must be
33.7% with leukopenia at admission. Elevated CRP levels carefully monitored, particularly in patients at risk for
were typical, while abnormalities in ALT, AST, creatine secondary infections like A. baumannii, as prolonged
kinase, and D-dimer were observed less frequently. corticosteroid use can suppress immune function and
Patients with severe COVID-19 displayed more significant potentially exacerbate infection risk.
laboratory abnormalities, including lymphocytopenia,
leukopenia, hypoalbuminemia, elevated D-dimer, CRP, 5. Conclusion
and LDH levels compared to those with nonsevere disease. It is essential to acknowledge the limitations of this
In this study, abnormalities in renal function study, mainly the relatively small sample size. The severe
(creatinine), liver function (ALT, AST), ferritin, fibrinogen, pandemic conditions and study design also precluded
and D-dimer emerged as potential indicators of disease the inclusion of a control group of ICU patients without
progression. However, only creatinine demonstrated a COVID-19 for comparison. However, this study prompts
statistically significant association with mortality risk (RR reflection on care and operational practices for handling
6.13; P < 0.002). Among patients with elevated creatinine these patients, especially during a pandemic.
levels suggestive of renal dysfunction, 87.5% succumbed Laboratory results from COVID-19 patients admitted
to the disease. to an ICU are essential to assess the disease prognosis.
Acute kidney injury (AKI) is a frequent complication Comprehensive information on clinical and laboratory
among hospitalized patients with severe COVID-19. parameters of coronaviruses is crucial for implementing
Although its incidence varies, studies report rates between effective management and reducing their impact in future
37% and 40%. In a retrospective observational cohort outbreaks. Emphasis should be placed on understanding
study in the U.S., 39.9% of 9,657 patients developed AKI. the disease’s pathophysiology, as well as on the early
These patients had a higher prevalence of comorbidities, detection and isolation of suspected patients, which play
including diabetes mellitus, coronary artery disease, heart significant clinical and social roles while enabling better
failure, and chronic kidney disease, as well as elevated adaptation of drug therapies. In this study, the laboratory
inflammatory markers such as D-dimer, CRP, and serum parameters were closely integrated into the clinical staff’s
ferritin. The mortality rate among patients with COVID-19 decision-making process, making a relevant contribution
who developed AKI, particularly those requiring dialysis, to scientific and healthcare knowledge during the initial
was substantial, highlighting the importance of shared outbreak of COVID-19.
decision-making in the care of these critically ill patients. 15,16
Acknowledgments
A retrospective analysis of 536 COVID-19 patients
reported that although AKI was relatively uncommon The authors thank physicians André Scheibler, Patrícia
(occurring in 36 cases), it was associated with a mortality Alcantara, Raphael Trinidad, and Marco Thomaz for
rate of 91.7%. Several mechanisms, including sepsis assisting with authorization requests, data acquisition, and
17
and direct viral infection of renal cells, contribute to manuscript revision.
the development of acute renal failure, particularly in
critically ill patients. Early identification of AKI is crucial Funding
in initiating appropriate treatment to improve outcomes. 18 The work was supported by the Capes Finance Code 001.

Volume 11 Issue 1 (2025) 31 doi: 10.36922/jctr.24.00036