During the COVID-19 pandemic, the RECOVERY trial established a survival benefit for dexamethasone. In which group of hospitalised patients was this mortality benefit demonstrated?

• A All hospitalised patients regardless of oxygen requirement
• B Ambulatory patients with mild disease and risk factors
• C Only patients with PCR-confirmed disease treated within 48 hours of symptom onset
• D Patients receiving invasive mechanical ventilation or supplemental oxygen ✓

Explanation

The RECOVERY trial showed reduced 28-day mortality with dexamethasone only among hospitalised patients who required respiratory support: roughly one-fifth relative mortality reduction in ventilated patients and a smaller benefit in those on oxygen alone. Patients not requiring oxygen derived no benefit, and corticosteroids may cause harm in early or mild disease because they blunt the protective antiviral immune response. Dexamethasone is therefore not recommended for ambulatory or mild cases.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.