There is a need for treatments to reduce coronavirus disease 2019 (COVID-19) mortality. Alpha-2 adrenergic receptor (α 2 AR) agonists can dampen immune cell and inflammatory responses as well as improve oxygenation through physiologic respiratory parameters. Therefore, α 2 AR agonists may be effective in reducing mortality related to hyperinflammation and acute respiratory failure in COVID-19. Dexmedetomidine (DEX) is an α 2 AR agonist used for sedation. We performed a retrospective analysis of adults at Rush University System for Health hospitals between March 1, 2020 and July 30, 2020 with COVID-19 requiring invasive mechanical ventilation and sedation ( n = 214). We evaluated the association of DEX use and 28-day mortality from time of intubation. Overall, 28-day mortality in the cohort receiving DEX was 27.0% as compared to 64.5% in the cohort that did not receive DEX (relative risk reduction 58.2%; 95% CI 42.4–69.6). Use of DEX was associated with reduced 28-day mortality on multivariable Cox regression analysis (aHR 0.19; 95% CI 0.10–0.33; p < 0.001). Adjusting for time-varying exposure to DEX also demonstrated that DEX was associated with reduced 28-day mortality (aHR 0.51; 95% CI 0.28–0.95; p = 0.03). Earlier DEX use, initiated <3.4 days from intubation, was associated with reduced 28-day mortality (aHR 0.25; 95% CI 0.13–0.50; p < 0.001) while later DEX use was not (aHR 0.64; 95% CI 0.27–1.50; p = 0.30). These results suggest an α 2 AR agonist might reduce mortality in patients with COVID-19. Randomized controlled trials are needed to confirm this observation.
【저자키워드】 Mortality, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Coronavirus disease 2019 (COVID-19), dexmedetomidine, alpha-2 adrenergic receptor agonist, 【초록키워드】 COVID-19, Treatment, coronavirus disease, Respiratory failure, hospital, 28-day mortality, intubation, Cohort, hyperinflammation, Controlled trial, Retrospective analysis, receptor, university, association, Invasive mechanical ventilation, Inflammatory response, Analysis, Immune cell, Oxygenation, observation, Sedation, 95% CI, reducing mortality, respiratory parameters, agonist, risk reduction, multivariable Cox regression, System, effective, reduce mortality, IMPROVE, performed, evaluated, receiving, reduced, demonstrated, initiated, reduce, receive, Adjusting, patients with COVID-19, with COVID-19, 【제목키워드】 COVID-19, Adrenergic, agonist,