Effect of dexamethasone dose on outcomes in acute COVID-19 disease: A systematic review and meta-analysis

J Infect. 2023 Dec;87(6):490-497. doi: 10.1016/j.jinf.2023.09.008. Epub 2023 Sep 25.


Introduction: The impact of different doses of dexamethasone on outcomes from acute COVID-19 pneumonia is unknown.

Methods: We performed a systematic review and meta-analysis of randomised control trials comparing different doses of dexamethasone in adult patients with COVID-19. High dose dexamethasone treatment was defined as 12-24 mg daily, whereas low-dose treatment was 6-8 mg daily. Primary outcome was 28-day mortality.

Results: Eight trials including 3469 patients were identified, with 1775 patients receiving high dose dexamethasone. There was no difference in mortality between patients receiving high dose or low-dose dexamethasone (22.0% vs. 20.2%; odds ratio 1.20 [95% confidence interval 0.86-1.67]; p = 0.29; I2 = 63%; TSA-adjusted CI [0.31-4.66]; very low QoE). Meta-regression did not demonstrate a dose-dependent effect of steroids on mortality. High dose dexamethasone was associated with an increased risk of hyperglycaemia (23.6% vs. 17.2%; 1.51 [1.19-1.92]; p = 0.0008; I2 = 0%; TSA-adjusted CI [0.90-2.54]; low QoE) but not secondary infections (14.3% vs. 15.0%; 0.87 [0.56-1.37]; p = 0.56; I2 = 72%; very low QoE). Risk of bias was low for seven of the eight studies.

Conclusions: The mortality of patients with acute COVID-19 receiving high-dose dexamethasone is similar to patients receiving low-dose dexamethasone, although high-dose dexamethasone is associated with an increased risk of hyperglycaemia.

Keywords: Acute respiratory distress syndrome; COVID-19; Dexamethasone; Meta-analysis; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • COVID-19 Drug Treatment
  • COVID-19*
  • Dexamethasone / adverse effects
  • Humans
  • Hyperglycemia* / drug therapy


  • Dexamethasone