Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients
, Marzia Bonsignore 5,6, Ralf Kuhlen 7, Irit Nachtigall 8,9 and Selcuk Tasci 10Round 1
Reviewer 1 Report
The Authors presented a retrospective observational study aimed to clarify the impact of dexamethasone on pathogen profile on 1776 critically ill COVID 19 patients, mechanically ventilated or not. The major strenght of the study was to add information on the effects of steroid therapy in COVID-19 patients. on teh other hands, new therapeutic strategies have already limited the indication to this therapy. In addiction, as reported in the Limitations section, the design of the study does not allow to differentiate clinically relevant infections.
Minor comments:
- i suggest to better clarify the characteristics of population study in terms of clinical history (comorbidities, therapy), COVID-19 status (vaccination, duration of disease) laboratory paramenters (i.e PCR, PCT, D-dimer, LDH), radiological phindings (CT severity score)
Author Response
Thank you for your remark. We specified the study population in accordance with our data by adding the percentage of comorbidities and the patient number receiving antiviral treatment.
Unfortunately, we have neihter examined laboratory parameters nor the specific radiological findings nor the immunization status. We added an explanation in the Limitations section: "Furthermore, clinical characteristics of the study population like vaccination status or severity of disease (e.g. laboratory parameters and radiological findings) has not been collected during the study period."
Reviewer 2 Report
I have read the exciting manuscript by Kodde et al. about the impact of dexamethasone on pathogen profile of critically ill patients with COVID-19. Few data (risk increased significantly in patients aged 80 years or older by 3.3-fold) about this topic are fundamental. I recommend this paper to be published in the journal. Here are some suggestions:
1. There is a lack of recent literature citations. For example, in line 51, “Up to this date, there is no specific treatment of COVID-19. (Front. Pharmacol. 2022, 13, 926507)”; in lines 53-55, “These include antiviral drugs (Biomedicines. 2021, 9, 689), anti-SARS-CoV-2 monoclonal antibodies (Viruses. 2022, 14, 443) and immunomodulatory therapeutics (Viruses. 2023, 15, 871) that help the immune system recognize and fight SARS-CoV-2.”
2. In the face of this epidemic, traditional Chinese medicine has also played a significant role in treating COVID-19. Please add relevant statements in “Introduction”.
3. “Table 2.” should be improved.
4. In line 216, “Covid-19” --- “COVID-19”.
5. In lines 62, “critical ill Covid-19 patients”---“critically ill COVID-19 patients”
6. The “Discussion”, authors should provide more concise insights.
Minor editing of English language required
Author Response
Please see the attachment.
Author Response File: 
Author Response.docx
