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Dexamethasone in outpatients with SARS-CoV-2 infection

Objective: To evaluate the clinical evolution of outpatients with SARS Cov-2 infection, who received dexamethasone in our Health Center.
Methods: The medical records of the patients who were prescribed dexamethasone treatment from Primary Care, in the acute phase of the SARS-CoV-2 infection, were reviewed, without initial criteria of severity. We describe the clinical-demographic characteristics and the radiological and analytical data of the cytokine storm, as well as its final evolution.
Results: a total of 9 patients were included, 6 women and 3 men with a mean age of 56.6 (34-74) years. The reason for consultation was fever in all cases, with a mean time of 4 (2-7) days from onset of symptoms to consultation. All patients presented a relationship between oxygen saturation and inspired oxygen fraction greater than 450. Out of these, 5 patients presented radiological findings compatible with COVID and no infiltrates were observed in 4. No patient had laboratory data for cytokine storm syndrome. The recommended dexamethasone dose was 6 mg/d for 7 days. In 3 cases, hospital admission was required, 2 on the third day and one on the fourth day after the start of dexamethasone. These patients resolved the in-hospital process with pulses of corticosteroids and antibiotics, without the need for high-flow oxygen therapy or mechanical ventilation.
Conclusions: the use of dexamethasone in patients with SARS-CoV-2 infection without hospital admission criteria does not seem to prevent the risk of progression to more serious forms. In the absence of more data, the use of dexamethasone in these cases does not seem advisable, unless it is required for other reasons.