Inflammatory organ injury may occur in severe Covid-19, with a subgroup of patients having markedly elevated levels of inflammatory markers, including C-reactive protein, ferritin, interleukin-1, and interleukin-6. 9 In other severe viral pneumonias, such as highly pathogenic avian influenza, 10 SARS, 11 and pandemic and seasonal influenza, 12 the host immune response is thought to play a key role in the pathophysiology of organ failure. The pathophysiological features of severe Covid-19 are dominated by an acute pneumonic process with extensive radiologic opacity and, on autopsy, diffuse alveolar damage, inflammatory infiltrates, and microvascular thrombosis. 7 Although remdesivir has been shown to shorten the time until recovery in hospitalized patients, 8 no therapeutic agents have been shown to reduce mortality. 3-6 Among patients with Covid-19 who were admitted to hospitals in the United Kingdom in the first half of 2020, the case fatality rate was approximately 26% overall and more than 37% among patients who were undergoing invasive mechanical ventilation. However, in a substantial percentage of patients, a respiratory illness requiring hospital care develops, 2 and such infections can progress to critical illness with hypoxemic respiratory failure requiring prolonged ventilatory support.
1 The majority of Covid-19 cases either are asymptomatic or result in only mild disease. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (Covid-19), emerged in China in late 2019 from a zoonotic source. (Funded by the Medical Research Council and National Institute for Health Research and others RECOVERY number, NCT04381936 ISRCTN number, 50189673.) Introduction In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. 26.2% rate ratio, 0.82 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 41.4% rate ratio, 0.64 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83 95% confidence interval, 0.75 to 0.93 P<0.001). ResultsĪ total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Here, we report the final results of this assessment. The primary outcome was 28-day mortality.
NY TAKE FIVE RESULTS FEBRUARY 25 RESULTS TRIAL
In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. The most trusted, influential source of new medical knowledge and clinical best practices in the world.Ĭoronavirus disease 2019 (Covid-19) is associated with diffuse lung damage.
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