tetano
Editor, Senior Moderator
J Cardiothorac Vasc Anesth
. 2022 May 13;S1053-0770(22)00336-6.
doi: 10.1053/j.jvca.2022.05.011. Online ahead of print.
High-Dose versus Low-Dose Corticosteroids in COVID-19 Patients: a Systematic Review and Meta-analysis
Rachel Si Jing Tan[SUP] 1 [/SUP], Ka Ting Ng[SUP] 2 [/SUP], Chua Ee Xin[SUP] 3 [/SUP], Rafidah Atan[SUP] 1 [/SUP], Nor'azim Mohd Yunos[SUP] 1 [/SUP], M Shahnaz Hasan[SUP] 1 [/SUP]
Affiliations
Abstract
Objectives: The clinical efficacy of corticosteroids remains unclear. The primary aim of this systematic review and meta-analysis was to evaluate the use of high-dose versus low- dose corticosteroids on the mortality rate of COVID-19 patients.
Design: Systematic review and meta-analysis.
Setting: Electronic search for randomized controlled trials and observational studies (MEDLINE, EMBASE, CENTRAL).
Participants: Hospitalized adults ≥ 18 years old who were SARS-CoV-2 PCR positive.
Interventions: High-dose and low-dose corticosteroids.
Measurements and main results: A total of twelve studies (n=2759 patients) were included in this review. The pooled analysis demonstrated no significant difference in mortality rate between the high-dose and low-dose corticosteroids groups (n=2632; OR: 1.07 [95%CI 0.67, 1.72], p=0.77, I[SUP]2[/SUP]=76%, trial sequential analysis=inconclusive). No significant differences were observed in the incidence of intensive care unit (ICU) admission rate (n=1544; OR: 0.77[95%CI 0.43, 1.37], p=0.37, I[SUP]2[/SUP]= 72%), duration of hospital stay (n=1615; MD: 0.53[95%CI -1.36, 2.41], p=0.58, I[SUP]2[/SUP]=87%), respiratory support (n=1694; OR: 1.51[95%CI 0.77, 2.96], p=0.23, I[SUP]2[/SUP]=84%), duration of mechanical ventilation (n=419; MD: -1.44[95%CI -4.27, 1.40], p=0.32, I[SUP]2[/SUP]=93%), incidence of hyperglycemia (n=516, OR: 0.91[95%CI 0.58, 1.43], p=0.68, I[SUP]2[/SUP]=0%) and infection rate (n=1485, OR: 0.86[95%CI 0.64, 1.16], p=0.33, I[SUP]2[/SUP]=29%).
Conclusion: The meta-analysis demonstrated high-dose corticosteroids did not reduce mortality rate. However, high-dose corticosteroids did not pose higher risk of hyperglycemia and infection rate for COVID-19 patients. Due to the inconclusive trial sequential analysis, substantial heterogeneity and low level of evidence, future large-scale randomized clinical trials are warranted to improve the certainty of evidence for the use of high-dose compared to low-dose corticosteroids in COVID-19 patients.
Keywords: COVID-19; Coronavirus; Corticosteroids; Dexamethasone; Methylprednisolone; SARS-CoV-2.
. 2022 May 13;S1053-0770(22)00336-6.
doi: 10.1053/j.jvca.2022.05.011. Online ahead of print.
High-Dose versus Low-Dose Corticosteroids in COVID-19 Patients: a Systematic Review and Meta-analysis
Rachel Si Jing Tan[SUP] 1 [/SUP], Ka Ting Ng[SUP] 2 [/SUP], Chua Ee Xin[SUP] 3 [/SUP], Rafidah Atan[SUP] 1 [/SUP], Nor'azim Mohd Yunos[SUP] 1 [/SUP], M Shahnaz Hasan[SUP] 1 [/SUP]
Affiliations
- PMID: 35715291
- DOI: 10.1053/j.jvca.2022.05.011
Abstract
Objectives: The clinical efficacy of corticosteroids remains unclear. The primary aim of this systematic review and meta-analysis was to evaluate the use of high-dose versus low- dose corticosteroids on the mortality rate of COVID-19 patients.
Design: Systematic review and meta-analysis.
Setting: Electronic search for randomized controlled trials and observational studies (MEDLINE, EMBASE, CENTRAL).
Participants: Hospitalized adults ≥ 18 years old who were SARS-CoV-2 PCR positive.
Interventions: High-dose and low-dose corticosteroids.
Measurements and main results: A total of twelve studies (n=2759 patients) were included in this review. The pooled analysis demonstrated no significant difference in mortality rate between the high-dose and low-dose corticosteroids groups (n=2632; OR: 1.07 [95%CI 0.67, 1.72], p=0.77, I[SUP]2[/SUP]=76%, trial sequential analysis=inconclusive). No significant differences were observed in the incidence of intensive care unit (ICU) admission rate (n=1544; OR: 0.77[95%CI 0.43, 1.37], p=0.37, I[SUP]2[/SUP]= 72%), duration of hospital stay (n=1615; MD: 0.53[95%CI -1.36, 2.41], p=0.58, I[SUP]2[/SUP]=87%), respiratory support (n=1694; OR: 1.51[95%CI 0.77, 2.96], p=0.23, I[SUP]2[/SUP]=84%), duration of mechanical ventilation (n=419; MD: -1.44[95%CI -4.27, 1.40], p=0.32, I[SUP]2[/SUP]=93%), incidence of hyperglycemia (n=516, OR: 0.91[95%CI 0.58, 1.43], p=0.68, I[SUP]2[/SUP]=0%) and infection rate (n=1485, OR: 0.86[95%CI 0.64, 1.16], p=0.33, I[SUP]2[/SUP]=29%).
Conclusion: The meta-analysis demonstrated high-dose corticosteroids did not reduce mortality rate. However, high-dose corticosteroids did not pose higher risk of hyperglycemia and infection rate for COVID-19 patients. Due to the inconclusive trial sequential analysis, substantial heterogeneity and low level of evidence, future large-scale randomized clinical trials are warranted to improve the certainty of evidence for the use of high-dose compared to low-dose corticosteroids in COVID-19 patients.
Keywords: COVID-19; Coronavirus; Corticosteroids; Dexamethasone; Methylprednisolone; SARS-CoV-2.