# Dexamethasone versus methylprednisolone for multiple organ dysfunction in COVID-19 critically ill patients: a multicenter propensity score matching study

## TL;DR

This study compared dexamethasone and methylprednisolone in critically ill COVID-19 patients and found dexamethasone to be more effective in reducing organ dysfunction, though both had similar mortality rates.

## Contribution

The study provides novel evidence on the comparative effectiveness of dexamethasone versus methylprednisolone in reducing organ dysfunction in critically ill COVID-19 patients.

## Key findings

- Dexamethasone was associated with lower multiple organ dysfunction scores on day three of ICU admission compared to methylprednisolone.
- Methylprednisolone was linked to a higher risk of hospital-acquired infections.
- No significant difference in 30-day or in-hospital mortality was observed between the two treatments.

## Abstract

Dexamethasone usually recommended for patients with severe coronavirus disease 2019 (COVID-19) to reduce short-term mortality. However, it is uncertain if another corticosteroid, such as methylprednisolone, may be utilized to obtain better clinical outcome. This study assessed dexamethasone’s clinical and safety outcomes compared to methylprednisolone.

A multicenter, retrospective cohort study was conducted between March 01, 2020, and July 31, 2021. It included adult COVID-19 patients who were initiated on either dexamethasone or methylprednisolone therapy within 24 h of intensive care unit (ICU) admission. The primary outcome was the progression of multiple organ dysfunction score (MODS) on day three of ICU admission. Propensity score (PS) matching was used (1:3 ratio) based on the patient’s age and MODS within 24 h of ICU admission.

After Propensity Score (PS) matching, 264 patients were included; 198 received dexamethasone, while 66 patients received methylprednisolone within 24 h of ICU admission. In regression analysis, patients who received methylprednisolone had a higher MODS on day three of ICU admission than those who received dexamethasone (beta coefficient: 0.17 (95% CI 0.02, 0.32), P = 0.03). Moreover, hospital-acquired infection was higher in the methylprednisolone group (OR 2.17, 95% CI 1.01, 4.66; p = 0.04). On the other hand, the 30-day and the in-hospital mortality were not statistically significant different between the two groups.

Dexamethasone showed a lower MODS on day three of ICU admission compared to methylprednisolone, with no statistically significant difference in mortality.

The online version contains supplementary material available at 10.1186/s12879-024-09056-y.