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Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis.
Ye, Zhikang; Wang, Ying; Colunga-Lozano, Luis Enrique; Prasad, Manya; Tangamornsuksan, Wimonchat; Rochwerg, Bram; Yao, Liang; Motaghi, Shahrzad; Couban, Rachel J; Ghadimi, Maryam; Bala, Malgorzata M; Gomaa, Huda; Fang, Fang; Xiao, Yingqi; Guyatt, Gordon H.
  • Ye Z; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Wang Y; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Colunga-Lozano LE; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Prasad M; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Tangamornsuksan W; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Rochwerg B; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Yao L; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Motaghi S; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Couban RJ; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Ghadimi M; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Bala MM; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Gomaa H; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Fang F; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Xiao Y; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
  • Guyatt GH; Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clini
CMAJ ; 192(27): E756-E767, 2020 07 06.
Article in English | MEDLINE | ID: covidwho-262616
Semantic information from SemMedBD (by NLM)
1. Adrenal Cortex Hormones ASSOCIATED_WITH COVID-19
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Adrenal Cortex Hormones
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ASSOCIATED_WITH
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COVID-19
2. Adrenal Cortex Hormones TREATS COVID-19
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Adrenal Cortex Hormones
Predicate
TREATS
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COVID-19
3. COVID-19 PROCESS_OF Patients
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COVID-19
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PROCESS_OF
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4. Adrenal Cortex Hormones TREATS Patients
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Adrenal Cortex Hormones
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Patients
5. Adrenal Cortex Hormones ASSOCIATED_WITH Acute illness
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Adrenal Cortex Hormones
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ASSOCIATED_WITH
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Acute illness
6. Adrenal Cortex Hormones NEG_TREATS COVID-19
Subject
Adrenal Cortex Hormones
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NEG_TREATS
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COVID-19
7. Adrenal Cortex Hormones compared_with Adrenal Cortex Hormones
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Adrenal Cortex Hormones
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compared_with
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Adrenal Cortex Hormones
8. Adrenal Cortex Hormones NEG_TREATS Patients
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Adrenal Cortex Hormones
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NEG_TREATS
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Patients
9. Respiratory Distress Syndrom PROCESS_OF C0030705
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Respiratory Distress Syndrom
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PROCESS_OF
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C0030705
10. Adrenal Cortex Hormones ASSOCIATED_WITH COVID-19
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Adrenal Cortex Hormones
Predicate
ASSOCIATED_WITH
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COVID-19
11. Adrenal Cortex Hormones TREATS COVID-19
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Adrenal Cortex Hormones
Predicate
TREATS
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COVID-19
12. COVID-19 PROCESS_OF Patients
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COVID-19
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PROCESS_OF
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Patients
13. Adrenal Cortex Hormones TREATS Patients
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Adrenal Cortex Hormones
Predicate
TREATS
Object
Patients
14. Adrenal Cortex Hormones ASSOCIATED_WITH Acute illness
Subject
Adrenal Cortex Hormones
Predicate
ASSOCIATED_WITH
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Acute illness
15. Adrenal Cortex Hormones NEG_TREATS COVID-19
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Adrenal Cortex Hormones
Predicate
NEG_TREATS
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COVID-19
16. Adrenal Cortex Hormones compared_with Adrenal Cortex Hormones
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Adrenal Cortex Hormones
Predicate
compared_with
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Adrenal Cortex Hormones
17. Adrenal Cortex Hormones NEG_TREATS Patients
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Adrenal Cortex Hormones
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NEG_TREATS
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Patients
18. Respiratory Distress Syndrome, Adult PROCESS_OF Patients
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Respiratory Distress Syndrome, Adult
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ABSTRACT

BACKGROUND:

Very little direct evidence exists on use of corticosteroids in patients with coronavirus disease 2019 (COVID-19). Indirect evidence from related conditions must therefore inform inferences regarding benefits and harms. To support a guideline for managing COVID-19, we conducted systematic reviews examining the impact of corticosteroids in COVID-19 and related severe acute respiratory illnesses.

METHODS:

We searched standard international and Chinese biomedical literature databases and prepublication sources for randomized controlled trials (RCTs) and observational studies comparing corticosteroids versus no corticosteroids in patients with COVID-19, severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS). For acute respiratory distress syndrome (ARDS), influenza and community-acquired pneumonia (CAP), we updated the most recent rigorous systematic review. We conducted random-effects meta-analyses to pool relative risks and then used baseline risk in patients with COVID-19 to generate absolute effects.

RESULTS:

In ARDS, according to 1 small cohort study in patients with COVID-19 and 7 RCTs in non-COVID-19 populations (risk ratio [RR] 0.72, 95% confidence interval [CI] 0.55 to 0.93, mean difference 17.3% fewer; low-quality evidence), corticosteroids may reduce mortality. In patients with severe COVID-19 but without ARDS, direct evidence from 2 observational studies provided very low-quality evidence of an increase in mortality with corticosteroids (hazard ratio [HR] 2.30, 95% CI 1.00 to 5.29, mean difference 11.9% more), as did observational data from influenza studies. Observational data from SARS and MERS studies provided very low-quality evidence of a small or no reduction in mortality. Randomized controlled trials in CAP suggest that corticosteroids may reduce mortality (RR 0.70, 95% CI 0.50 to 0.98, 3.1% lower; very low-quality evidence), and may increase hyperglycemia.

INTERPRETATION:

Corticosteroids may reduce mortality for patients with COVID-19 and ARDS. For patients with severe COVID-19 but without ARDS, evidence regarding benefit from different bodies of evidence is inconsistent and of very low quality.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Respiratory Distress Syndrome / Adrenal Cortex Hormones / Coronavirus Infections / Community-Acquired Infections / Influenza, Human / Betacoronavirus Type of study: Controlled clinical trial / Etiology study / Clinical Practice Guide / Observational study / Evidence synthesis / Randomized controlled trials / Reviews / Risk factors / Systematic review Limits: Humans Language: English Journal: CMAJ Journal subject: Medicine Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Respiratory Distress Syndrome / Adrenal Cortex Hormones / Coronavirus Infections / Community-Acquired Infections / Influenza, Human / Betacoronavirus Type of study: Controlled clinical trial / Etiology study / Clinical Practice Guide / Observational study / Evidence synthesis / Randomized controlled trials / Reviews / Risk factors / Systematic review Limits: Humans Language: English Journal: CMAJ Journal subject: Medicine Year: 2020 Document Type: Article