Impact of Dexamethasone on Respiratory Sequelae in the Follow-Up of Hospitalized Patients with Sars-Cov-2 Pneumonia

David Espejo-Castellanos,1,2 María-Florencia Pilia,1 Maria A Ramon,1 Saliha Omari,1 Christian Romero-Mesones,1,2 Iñigo Ojanguren,1,2 Maria-Jesus Cruz,1,2 Xavier Muñoz1– 3 On behalf of Se-COVID-19 Team1Pulmonology Service, Department of Medicine, Vall d’Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; 2CIBER of Respiratory Diseases (CIBERES), Barcelona, Spain; 3Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, SpainCorrespondence: Maria-Jesus Cruz, Pulmonology Service, Hospital Universitario Vall d’Hebron, Passeig Vall d’Hebron 119, Barcelona, 08035, Spain, Tel +342746157, Email mj.cruz@vhir.orgIntroduction: Dexamethasone has been shown to reduce 28-day mortality in COVID-19 patients requiring oxygen, but its effect on long-term pulmonary complications remains unclear. This study aimed to assess whether treatment with dexamethasone in the acute phase of SARS-CoV-2 pneumonia improves post-COVID clinical outcomes.Methods: This longitudinal retrospective study analysed patients hospitalized for SARS-CoV-2 pneumonia between March 2020 and April 2021. Patients were stratified according to dexamethasone treatment during hospitalization. They were evaluated 3– 9 months post- discharge using clinical assessments, pulmonary function tests, and imaging studies. We compared the demographic, clinical, and functional characteristics according to dexamethasone treatment. Multivariate linear and logistic regression models were used to assess the association between dexamethasone and main outcome follow-up variables.Results: In a study of 1,011 patients hospitalized for SARS-CoV-2 pneumonia, 663 received dexamethasone treatment while 348 did not. During post-COVID follow-up, dexamethasone-treated patients reported less dyspnea (28.4% vs 37.6%, p=0.003); showed better lung function, particularly in DLCO (76.9% vs 69.9%, p< 0.001), and better performance in the 6-minute walk test (435 meters vs 405 meters, p=0.002) Radiologically, these patients had lower degrees of reticulation (4,4% vs 9,5%; p=0,009), septal thickening (5,8% vs 10,5%; p=0,012) and fibrosis (3,5% vs 15,6%; p=< 0,001). Although rates of bronchial involvement were similar, dexamethasone-treated patients had less bronchiolitis but more bronchiectasis and bronchial thickening. Dexamethasone treatment increased DLCO by 9.25 points (95% CI: 0.50– 18.00; p=0.038) and significantly reduced the risk of fibrosis (OR=0.24; 95% CI: 0.12– 0.49) in multivariate analysis.Conclusion: Patients treated with dexamethasone showed improved post-COVID respiratory outcomes, including less dyspnea, better lung function, and fewer signs of fibrosis. These findings suggest that dexamethasone is associated with improved outcomes after severe COVID-19 pneumonia.Keywords: long-term complications, lung fibrosis, dyspnea, COVID-19