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

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.