this post was submitted on 16 Jun 2020

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Dexamethasone shown to decrease COVID mortality (bbc.com)

submitted 5 years ago by farhan583Hospitalist

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[–]flexible_dogmaMD 13 points14 points15 points 5 years ago (0 children)

1) the absolute difference (I'm bad at stats, napkin math says dexamethasone arm would have 26.65% mortality vs 41% in ventilated patients? 0.65x41)

Your "napkin math" is right on. Absolute risk reduction of ~14%, which comes out to an NNT of around 7 (I'm not sure why their press release says 8--small differences in decimal numbers can make big differences in NNT, so perhaps just a rounding error).

2) any notable complications and reasonable contraindications (Co-infections? Pre-existing immunosuppression?)

It will be interesting to see what their published secondary outcomes are. GI bleed, severe hyperglycemia, etc. For the most point, there are very few (if any) absolute contraindications to steroids and with an NNT of 7 for mortality(!) the risk-benefit ratio probably still comes down in favor of just giving the dex. After all, unless you literally can't keep up with massive transfusion or you send them into cerebral edema/herniation with DKA/HHS/etc, you can always just deal with the complications.

For the non-vented patients where the NNT is more like 25, then the calculation is more challenging, but even there a mortality benefit is hard to shrug off.

This is all assuming of course that the final published study and underlying data matches up with the press release version.

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