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Comparison of Associations Between Glucocorticoids Treatment and Mortality in COVID-19 Patients and SARS Patients: A Systematic Review and Meta-Analysis.
Li, Jianbo; Liao, Xuelian; Zhou, Yue; Wang, Luping; Yang, Hang; Zhang, Wei; Zhang, Zhongwei; Kang, Yan.
  • Li J; Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
  • Liao X; Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
  • Zhou Y; Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
  • Wang L; Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
  • Yang H; Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
  • Zhang W; Molecular Medicine Research Center, State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
  • Zhang Z; Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
  • Kang Y; Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Shock ; 56(2): 215-228, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1316855
ABSTRACT

BACKGROUND:

The response to glucocorticoids treatment may be different between coronavirus disease 2019 (Covid-19) and severe acute respiratory syndrome (SARS).

METHODS:

In this systematic review and meta-analysis, we searched studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, ClinicalTrials.gov, International Clinical Trials Registry Platform from 2002 to October 7, 2020. We used fixed-effects and random-effects models to compute the risk ratio of death in the group receiving glucocorticoids treatment and the control group for COVID-19 and SARS, respectively.

RESULTS:

Ten trials and 71 observational studies, with a total of 45,935 patients, were identified. Glucocorticoids treatment was associated with decreased all-cause mortality both in COVID-19 (risk ratio, 0.88; 95% confidence interval, 0.82-0.94; I2 = 26%) and SARS (0.48; 0.29-0.79; 10%), based on high-quality evidence, as well as decreased all-cause mortality-including composite outcome of COVID-19 (0.89; 0.82-0.98; 0%). In subgroup analyses, all-cause mortality was significantly lower among COVID-19 patients being accompanied by severe ARDS but not mild ARDS, taking low-dose or pulse glucocorticoids, being critically severe but not only severe, being of critical severity and old but not young, being of critical severity and men but not women, non-early taking glucocorticoids, taking dexamethasone or methylprednisolone, and with the increased inflammatory state; but for SARS, lower mortality was observed among those who were taking medium-high dose glucocorticoids, being severe or critically severe, early taking glucocorticoids, and taking methylprednisolone or prednisolone.

CONCLUSIONS:

Glucocorticoids treatment reduced mortality in COVID-19 and SARS patients of critical severity; however, different curative effects existed between the two diseases among subpopulations, mainly regarding sex- and age-specific effects, optimal doses, and use timing of glucocorticoids.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pandemics / SARS-CoV-2 / COVID-19 Drug Treatment / Glucocorticoids Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Shock Journal subject: Vascular Diseases / Cardiology Year: 2021 Document Type: Article Affiliation country: SHK.0000000000001738

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pandemics / SARS-CoV-2 / COVID-19 Drug Treatment / Glucocorticoids Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Shock Journal subject: Vascular Diseases / Cardiology Year: 2021 Document Type: Article Affiliation country: SHK.0000000000001738