Clinical effects of dexamethasone among patients with sickle cell disease hospitalized with COVID-19: Outcomes from a single academic health system

Background Dexamethasone is a steroid used in the treatment of hospitalized patients with severe COVID-19. However, the effect of dexamethasone in patients with SCD remains unclear given that steroids may precipitate vaso-occlusive crisis (VOC) in patients with SCD. Methods and findings We performed a retrospective analysis of patients with SCD who were hospitalized at Johns Hopkins Health System between June 1, 2020 and June 26, 2022. We reviewed individual charts to assess severity of illness and eligibility for dexamethasone treatment. The exposure of interest was treatment with dexamethasone. Outcomes of interest included incident VTE, length of hospital stay, ICU admission, follow up-VOC and mortality. We identified 30 patients with SCD and COVID-19 who were eligible for dexamethasone treatment, 13 of whom received dexamethasone. Dexamethasone was associated with an increased risk of incident VTE (risk difference = 36%; 95% CI 8%, 66%) after adjustment for high-risk genotypes, > 3 hospitalizations, and receipt of anticoagulation. There was an increase in the risk difference of ICU admission and an increased length of stay in crude and adjusted analyses however these associations were not statistically significant. Conclusions We analyzed outcomes among patients with SCD who were hospitalized for COVID-19 and eligible for dexamethasone. Our study suggests that in this population, treatment with dexamethasone increases the risk of incident VTE. There was a suggestion of an increased risk of ICU admission as well as increased length of hospitalization; larger studies are needed to confirm these findings.