Evidence map›Paper›PMID 36862239›Full record

ArticleAnnals of intensive care2023

Effects of 12 mg vs. 6 mg dexamethasone on thromboembolism and bleeding in patients with critical COVID-19 - a post hoc analysis of the randomized, blinded COVID STEROID 2 trial.

Sandra Jonmarker, Felix Alarcón, Jacob Litorell, Anders Granholm, Eva Joelsson Alm, Michelle Chew, Lene Russell, Sarah Weihe, Emilie Kabel Madsen, Nick Meier and 9 more

Abstract read
In one paragraph

Article in Annals of intensive care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Sandra Jonmarker *Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden. sandra.jonmarker@ki.se.ORCID http://orcid.org/0000-0001-5836-8594
Felix Alarcón *Department of Anaesthesia and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83, Stockholm, Sweden.
Jacob LitorellDepartment of Anaesthesia and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83, Stockholm, Sweden.
Anders GranholmDepartment of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Eva Joelsson AlmDepartment of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Michelle ChewDepartment of Anaesthesia and Intensive Care Medicine, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Lene RussellDepartment of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Sarah WeiheDepartment of Anaesthesiology, Zealand University Hospital, Koege, Denmark.
Emilie Kabel MadsenDepartment of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Nick MeierDepartment of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Jens Wolfgang LeistnerDepartment of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Johan MårtenssonDepartment of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
Jacob HollenbergDepartment of Clinical Science and Education, Centre for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Anders PernerDepartment of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Maj-Brit Nørregaard KjærDepartment of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Marie Warrer MunchDepartment of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Martin DahlbergDepartment of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Maria CronhjortDepartment of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Rebecka Rubenson WahlinDepartment of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThromboembolism is more common in patients with critical COVID-19 than in other critically ill patients, and inflammation has been proposed as a possible mechanism. The aim of this study was to investigate if 12 mg vs. 6 mg dexamethasone daily reduced the composite outcome of death or thromboembolism in patients with critical COVID-19.

methodsUsing additional data on thromboembolism and bleeding we did a post hoc analysis of Swedish and Danish intensive care unit patients enrolled in the blinded randomized COVID STEROID 2 trial comparing 12 mg vs. 6 mg dexamethasone daily for up to 10 days. The primary outcome was a composite outcome of death or thromboembolism during intensive care. Secondary outcomes were thromboembolism, major bleeding, and any bleeding during intensive care.

resultsWe included 357 patients. Whilst in intensive care, 53 patients (29%) in the 12 mg group and 53 patients (30%) in the 6 mg group met the primary outcome with an unadjusted absolute risk difference of - 0.5% (95% CI - 10 to 9.5%, p = 1.00) and an adjusted OR of 0.93 (CI 95% 0.58 to 1.49, p = 0.77). We found no firm evidence of differences in any of the secondary outcomes.

conclusionsAmong patients with critical COVID-19, 12 mg vs. 6 mg dexamethasone daily did not result in a statistically significant difference in the composite outcome of death or thromboembolism. However, uncertainty remains due to the limited number of patients.

Indexed as

BleedingCOVID-19GlucocorticoidsIntensive carePulmonary embolismSteroidsThromboembolismThrombosis

Identifiers

PMID36862239
PMCPMC9979892

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.