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Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis.
Tlayjeh, Haytham; Mhish, Olaa H; Enani, Mushira A; Alruwaili, Alya; Tleyjeh, Rana; Thalib, Lukman; Hassett, Leslie; Arabi, Yaseen M; Kashour, Tarek; Tleyjeh, Imad M.
  • Tlayjeh H; Department of Intensive Care, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
  • Mhish OH; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
  • Enani MA; Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.
  • Alruwaili A; Clinical Pharmacy Department, Pharmacy Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia.
  • Tleyjeh R; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
  • Thalib L; Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
  • Hassett L; Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA.
  • Arabi YM; Department of Intensive Care, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
  • Kashour T; Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia.
  • Tleyjeh IM; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia; Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of Epidemiology,
J Infect Public Health ; 13(11): 1652-1663, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-803118
ABSTRACT

BACKGROUND:

To systematically review the literature about the association between systemic corticosteroid therapy (CST) and outcomes of COVID-19 patients.

METHODS:

We searched Medline, Embase, EBM Reviews, Scopus, Web of Science, and preprints up to July 20, 2020. We included observational studies and randomized controlled trials (RCT) that assessed COVID-19 patients treated with CST. We pooled adjusted effect estimates of mortality and other outcomes using a random effect model, among studies at low or moderate risk for bias. We assessed the certainty of evidence for each outcome using the GRADE approach.

RESULTS:

Out of 1067 citations screened for eligibility, one RCT and 19 cohort studies were included (16,977 hospitalized patients). Ten studies (1 RCT and 9 cohorts) with 10,278 patients examined the effect of CST on short term mortality. The pooled adjusted RR was 0.92 (95% CI 0.69-1.22, I2 = 81.94%). This effect was observed across all stages of disease severity. Four cohort studies examined the effect of CST on composite outcome of death, ICU admission and mechanical ventilation need. The pooled adjusted RR was 0.41(0.23-0.73, I2 = 78.69%). Six cohort studies examined the effect of CST on delayed viral clearance. The pooled adjusted RR was 1.47(95% CI 1.11-1.93, I2 = 43.38%).

CONCLUSION:

In this systematic review, as of July 2020, heterogeneous and low certainty cumulative evidence based on observational studies and one RCT suggests that CST was not associated with reduction in short-term mortality but possibly with a delay in viral clearance in patients hospitalized with COVID-19 of different severities. However, the discordant results between the single RCT and observational studies as well as the heterogeneity observed across observational studies, call for caution in using observational data and suggests the need for more RCTs to identify the clinical and biochemical characteristics of patients' population that could benefit from CST.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Adrenal Cortex Hormones / Coronavirus Infections Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: J Infect Public Health Journal subject: Communicable Diseases / Public Health Year: 2020 Document Type: Article Affiliation country: J.jiph.2020.09.008

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Adrenal Cortex Hormones / Coronavirus Infections Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: J Infect Public Health Journal subject: Communicable Diseases / Public Health Year: 2020 Document Type: Article Affiliation country: J.jiph.2020.09.008