{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:02:33Z","timestamp":1787022153880,"version":"build-2736575974"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T00:00:00Z","timestamp":1724112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Among therapeutic options for severe and critical COVID- 19 infection, dexamethasone six milligrams once daily for ten days has demonstrated mortality benefit and is guideline recommended at this dose. In practice, variable doses of steroids have been used, especially in critical care settings. Our study aimed to determine the pattern of steroid dosing and outcomes in terms of critical care mortality, occurrence of dysglycaemias, and occurrence of superadded infections in patients with critical COVID-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort study was carried out on all eligible patients admitted to the Aga Khan University Hospital, Nairobi, with critical COVID-19 between 1\n                      <jats:sup>st<\/jats:sup>\n                      March 2020 and 31\n                      <jats:sup>st<\/jats:sup>\n                      December 2021. The intervention of interest was corticosteroids quantified as the average daily dose in milligrams of dexamethasone. A steroid dose of six milligrams once a day was compared to high dose steroid dosing, which was defined as any dose greater than this. The primary outcome measure was ICU mortality and secondary outcomes included occurrence of dysglycaemias, superadded infections and duration of critical care admission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 288 patients. The median age was 61.2 years (IQR: 49.7, 72.5), with 71.2% of patients being male. The most common comorbidities were diabetes mellitus (60.7%), hypertension (58%), and heart disease (12.2%). The average oxygen saturation and C-reactive protein at admission were 82% [IQR: 70.0\u201389.0]and 113.0 [IQR: 54.0\u2013186.0], respectively. Fifty-eight percent of patients received a standard dose (6mg) of steroids. The mortality rate was higher in the high-dose group compared to the standard-dose group; however, the difference was not statistically significant (47.9% vs 43.7% p = 0.549). The two most common steroid associated adverse effects were uncomplicated hyperglycemia (62.2%) and superimposed bacterial pneumonia (20.1%). The high-dose group had a higher incidence of uncomplicated hyperglycemia compared to the standard-dose group (63.6% vs 61.1%). However, the incidence of diabetic ketoacidosis was lower in the high dose group (0.6% vs 6.6%). Oxygen saturation at admission was associated with survival where it was lower among non-survivor patients with critical COVID-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study found that high-dose steroids in the treatment of critically ill patients with COVID-19 pneumonia did not confer any mortality benefit and were associated with an increased risk of dysglycemia and superimposed infections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0307265","type":"journal-article","created":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T14:03:27Z","timestamp":1724162607000},"page":"e0307265","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Outcomes of different steroid dosing regimens in critical Covid-19 pneumonia at a Kenyan hospital: A retrospective cohort study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2316-0464","authenticated-orcid":true,"given":"John Otieno","family":"Odhiambo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmit","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Kunyiha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Makasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0409-8300","authenticated-orcid":true,"given":"Felix","family":"Riunga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,20]]},"reference":[{"issue":"8","key":"pone.0307265.ref001","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1056\/NEJMoa2021436","article-title":"Dexamethasone in Hospitalized Patients with Covid-19","volume":"384","author":"P. Horby","year":"2021","journal-title":"N Engl J Med"},{"issue":"13","key":"pone.0307265.ref002","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1001\/jama.2020.17021","article-title":"Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial","volume":"324","author":"B.M. Tomazini","year":"2020","journal-title":"Jama"},{"issue":"13","key":"pone.0307265.ref003","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1001\/jama.2020.17023","article-title":"Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19A Meta-analysis.","volume":"324","author":"J.A.C. Sterne","year":"2020","journal-title":"Jama"},{"issue":"5","key":"pone.0307265.ref004","doi-asserted-by":"crossref","first-page":"e0252057","DOI":"10.1371\/journal.pone.0252057","article-title":"Dexamethasone vs methylprednisolone high dose for Covid-19 pneumonia","volume":"16","author":"M.A. Pinz\u00f3n","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pone.0307265.ref005","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1186\/s12879-021-06045-3","article-title":"Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial","volume":"21","author":"K. Ranjbar","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"4","key":"pone.0307265.ref006","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1007\/s10096-020-04078-1","article-title":"High versus standard doses of corticosteroids in severe COVID-19: a retrospective cohort study","volume":"40","author":"E. Monreal","year":"2021","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"6","key":"pone.0307265.ref007","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.02808-2020","article-title":"Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial","volume":"56","author":"M. Edalatifard","year":"2020","journal-title":"Eur Respir J"},{"issue":"18","key":"pone.0307265.ref008","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1001\/jama.2021.18295","article-title":"Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia: The COVID STEROID 2 Randomized Trial.","volume":"326","author":"M.W. Munch","year":"2021","journal-title":"Jama"},{"issue":"10387","key":"pone.0307265.ref009","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1016\/S0140-6736(23)00510-X","article-title":"Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial","volume":"401","year":"2023","journal-title":"Lancet"},{"issue":"4","key":"pone.0307265.ref010","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1513\/AnnalsATS.202208-720OC","article-title":"Higher- versus Lower-Dose Corticosteroids for Severe to Critical COVID-19: A Systematic Review and Dose-Response Meta-analysis","volume":"20","author":"T. Pitre","year":"2023","journal-title":"Ann Am Thorac Soc"},{"issue":"9","key":"pone.0307265.ref011","doi-asserted-by":"crossref","first-page":"e1125","DOI":"10.1016\/S2214-109X(20)30318-1","article-title":"Dexamethasone for COVID-19: data needed from randomised clinical trials in Africa","volume":"8","author":"H. Brotherton","year":"2020","journal-title":"Lancet Glob Health"},{"issue":"10288","key":"pone.0307265.ref012","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1016\/S0140-6736(21)00441-4","article-title":"Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): a multicentre, prospective, observational cohort study","volume":"397","year":"2021","journal-title":"Lancet"},{"issue":"7","key":"pone.0307265.ref013","doi-asserted-by":"crossref","first-page":"e543","DOI":"10.1016\/S2666-5247(21)00237-8","article-title":"The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries","volume":"3","author":"M. Hoenigl","year":"2022","journal-title":"Lancet Microbe"},{"key":"pone.0307265.ref014","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"P.A. Harris","year":"2019","journal-title":"J Biomed Inform"},{"issue":"1","key":"pone.0307265.ref015","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3201\/eid2801.211636","article-title":"Outbreak of Mucormycosis in Coronavirus Disease Patients, Pune, India","volume":"28","author":"S. Joshi","year":"2022","journal-title":"Emerg Infect Dis"},{"issue":"12","key":"pone.0307265.ref016","doi-asserted-by":"crossref","first-page":"e0244171","DOI":"10.1371\/journal.pone.0244171","article-title":"Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru.","volume":"15","author":"F. Mej\u00eda","year":"2020","journal-title":"PLoS One"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0307265","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T14:03:43Z","timestamp":1724162623000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0307265"}},"subtitle":[],"editor":[{"given":"Robert Jeenchen","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,20]]},"references-count":16,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0307265","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,20]]}}}