Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes
| Autor: | Katinka M. I. Neumann, Judith van Paassen, Sesmu M. Arbous, Eva M. Hoekstra, Jeroen S. Vos, Pauline C. Boot |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Coronavirus disease 2019 (COVID-19) medicine.drug_class medicine.medical_treatment Secondary infection MEDLINE Viral clearance Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Mechanical ventilation Adrenal Cortex Hormones Oxygen therapy medicine Humans Corticosteroids 030212 general & internal medicine Hospital Mortality Mortality Intensive care medicine 0303 health sciences 030306 microbiology business.industry SARS-CoV-2 Research lcsh:Medical emergencies. Critical care. Intensive care. First aid COVID-19 lcsh:RC86-88.9 Length of Stay COVID-19 Drug Treatment Coronavirus Meta-analysis Corticosteroid Observational study business |
| Zdroj: | Critical Care Critical Care, Vol 24, Iss 1, Pp 1-22 (2020) Critical Care, 24(1). BMC |
| ISSN: | 1466-609X |
| Popis: | Background In the current SARS-CoV-2 pandemic, there has been worldwide debate on the use of corticosteroids in COVID-19. In the recent RECOVERY trial, evaluating the effect of dexamethasone, a reduced 28-day mortality in patients requiring oxygen therapy or mechanical ventilation was shown. Their results have led to considering amendments in guidelines or actually already recommending corticosteroids in COVID-19. However, the effectiveness and safety of corticosteroids still remain uncertain, and reliable data to further shed light on the benefit and harm are needed. Objectives The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of corticosteroids in COVID-19. Methods A systematic literature search of RCTS and observational studies on adult patients was performed across Medline/PubMed, Embase and Web of Science from December 1, 2019, until October 1, 2020, according to the PRISMA guidelines. Primary outcomes were short-term mortality and viral clearance (based on RT-PCR in respiratory specimens). Secondary outcomes were: need for mechanical ventilation, need for other oxygen therapy, length of hospital stay and secondary infections. Results Forty-four studies were included, covering 20.197 patients. In twenty-two studies, the effect of corticosteroid use on mortality was quantified. The overall pooled estimate (observational studies and RCTs) showed a significant reduced mortality in the corticosteroid group (OR 0.72 (95%CI 0.57–0.87). Furthermore, viral clearance time ranged from 10 to 29 days in the corticosteroid group and from 8 to 24 days in the standard of care group. Fourteen studies reported a positive effect of corticosteroids on need for and duration of mechanical ventilation. A trend toward more infections and antibiotic use was present. Conclusions Our findings from both observational studies and RCTs confirm a beneficial effect of corticosteroids on short-term mortality and a reduction in need for mechanical ventilation. And although data in the studies were too sparse to draw any firm conclusions, there might be a signal of delayed viral clearance and an increase in secondary infections. |
| Databáze: | OpenAIRE |
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