High-Dose versus Low-Dose Corticosteroids in COVID-19 Patients: a Systematic Review and Meta-analysis.
J Cardiothorac Vasc Anesth
; 36(9): 3576-3586, 2022 09.
Article
in English
| MEDLINE | ID: covidwho-1900688
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 MAINRESULTS:
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, I2=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, I2= 72%), duration of hospital stay (n=1615; MD 0.53[95%CI -1.36, 2.41], p=0.58, I2=87%), respiratory support (n=1694; OR 1.51[95%CI 0.77, 2.96], p=0.23, I2=84%), duration of mechanical ventilation (n=419; MD -1.44[95%CI -4.27, 1.40], p=0.32, I2=93%), incidence of hyperglycemia (n=516, OR 0.91[95%CI 0.58, 1.43], p=0.68, I2=0%) and infection rate (n=1485, OR 0.86[95%CI 0.64, 1.16], p=0.33, I2=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
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
COVID-19
/
Hyperglycemia
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
/
Reviews
/
Systematic review/Meta Analysis
Limits:
Adolescent
/
Adult
/
Humans
Language:
English
Journal:
J Cardiothorac Vasc Anesth
Journal subject:
Anesthesiology
/
Cardiology
Year:
2022
Document Type:
Article
Affiliation country:
J.jvca.2022.05.011
Similar
MEDLINE
...
LILACS
LIS