Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes
| Autor: | Edison J Cano, Omar Abu Saleh, Xavier Fonseca Fuentes, John C. O’Horo, Yewande Odeyemi, Hemang Yadav, Zelalem Temesgen, Cristina Corsini Campioli |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Mechanical ventilation
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.drug_class business.industry medicine.medical_treatment MEDLINE medicine.disease_cause Critical Care and Intensive Care Medicine Clinical trial 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Relative risk Meta-analysis medicine Corticosteroid 030212 general & internal medicine Dosing Intensive care medicine business Cardiology and Cardiovascular Medicine Coronavirus |
| Zdroj: | Chest |
| ISSN: | 0012-3692 |
| DOI: | 10.1016/j.chest.2020.10.054 |
| Popis: | Background Since its appearance in late 2019, infections caused by severe acute respiratory syndrome coronavirus 2 have created unprecedented challenges for health systems worldwide. Multiple therapeutic options have been explored, including corticosteroids. Preliminary results of corticosteroids in coronavirus disease 2019 (COVID-19) are encouraging; however, the role of corticosteroids remains controversial. Research Question What is the impact of corticosteroids in mortality, ICU admission, mechanical ventilation, and viral shedding in COVID-19 patients? Study Design and Methods We conducted a systematic review of literature on corticosteroids and COVID-19 in major databases (PubMed, MEDLINE, and EMBASE) of published literature through July 22, 2020, that report outcomes of interest in COVID-19 patients receiving corticosteroids with a comparative group. Results A total of 73 studies with 21,350 COVID-19 patients were identified. Corticosteroid use was reported widely in mechanically ventilated patients (35.3%), ICU patients (51.3%), and severe COVID-19 patients (40%). Corticosteroids showed mortality benefit in severelly ill COVID-19 patients (OR, 0.65; 95% CI, 0.51-0.83; P = .0006); however, no beneficial or harmful effects were noted among high-dose or low-dose corticosteroid regimens. Emerging evidence shows that low-dose corticosteroids do not have a significant impact in the duration of SARS-CoV-2 viral shedding. The analysis was limited by highly heterogeneous literature for high-dose and low-dose corticosteroids regimens. Interpretation Our results showed evidence of mortality benefit in severely ill COVID-19 patients treated with corticosteroids. Corticosteroids are used widely in COVID-19 patients worldwide, and a rapidly developing global pandemic warrants further high-quality clinical trials to define the most beneficial timing and dosing for corticosteroids. |
| Databáze: | OpenAIRE |
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