Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis.
Expert Rev Respir Med
; 14(11): 1149-1163, 2020 11.
Article
in English
| MEDLINE | ID: covidwho-690564
ABSTRACT
OBJECTIVES:
The acute respiratory distress syndrome (ARDS) secondary to viral pneumonitis is one of the main causes of high mortality in patients with COVID-19 (novel coronavirus disease 2019). We systematically reviewed mortality in COVID-19 patients with ARDS and the potential role of systemic corticosteroids in COVID-19 patients.METHODS:
Electronic databases and country-specific healthcare databases were searched to identify relevant studies/reports. The quality assessment of individual studies was conducted using the Newcastle-Ottawa Scale. Country-specific proportion of individuals with COVID-19 who developed ARDS and reported death were combined in a random-effect meta-analysis to give a pooled mortality estimate of ARDS.RESULTS:
The overall pooled mortality estimate among 10,815 ARDS cases in COVID-19 patients was 39% (95% CI 23-56%). The pooled mortality estimate for China was 69% (95% CI 67-72%). In Europe, the highest mortality estimate among COVID-19 patients with ARDS was reported in Poland (73%; 95% CI 58-86%) while Germany had the lowest mortality estimate (13%; 95% CI 2-29%) among COVID-19 patients with ARDS. 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 which includes 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
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pneumonia, Viral
/
Respiratory Distress Syndrome
/
Adrenal Cortex Hormones
/
Coronavirus Infections
/
Betacoronavirus
Type of study:
Prognostic study
/
Randomized controlled trials
/
Reviews
/
Systematic review/Meta Analysis
Topics:
Long Covid
Limits:
Humans
Language:
English
Journal:
Expert Rev Respir Med
Year:
2020
Document Type:
Article
Affiliation country:
17476348.2020.1804365
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