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Expert Rev Respir Med
. 2020 Jul 31.
doi: 10.1080/17476348.2020.1804365. Online ahead of print.
Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis
Syed Shahzad Hasan 1 , Toby Capstick 2 , Raees Ahmed 3 , Chia Siang Kow 4 , Faizan Mazhar 5 , Hamid A Merchant 1 , Syed Tabish Razi Zaidi 6
Affiliations
- PMID: 32734777
- DOI: 10.1080/17476348.2020.1804365
Abstract
Objectives: The acute respiratory distress syndrome (ARDS) secondary to viral pneumonitis is one of the main causes of high mortality in COVID-19 patients. We systematically reviewed ARDS-associated mortality and the potential role of systemic corticosteroids in COVID-19 patients.
Methods: Electronic databases and country-specific reports were searched to identify relevant studies. The mortality data from these studies were pooled for statistical analysis, and subgroup analysis and quality assessment were performed.
Results: The overall pooled mortality among 10,815 ARDS cases in COVID-19 patients was 39% (95% CI: 23-56%). The pooled mortality for China was 69% (95% CI: 67-72%). In Europe, the highest mortality among COVID-19 patients with ARDS was reported in Poland (73%; 95% CI: 58-86%) while Germany had the lowest mortality (13%; 95% CI: 2-29%). The median crude mortality rate of COVID-19 patients with reported corticosteroid use was 28.0% (lower quartile: 13.9%; upper quartile: 53.6%).
Conclusions: The high mortality in COVID-19 associated ARDS necessitates a prompt and aggressive treatment strategy including corticosteroids. Most of the studies included no information on the dosing regimen of corticosteroid therapy, however, low-dose corticosteroid therapy or pulse corticosteroid therapy appears to have a beneficial role in the management of severely ill COVID-19 patients.
Keywords: Acute respiratory distress syndrome; coronavirus disease 2019; corticosteroids; mortality.