Corticosteroids for Patients With Coronavirus Disease 2019 (COVID-19) With Different Disease Severity: A Meta-Analysis of Randomized Clinical Trials.
J Cardiothorac Vasc Anesth
; 35(2): 578-584, 2021 Feb.
Article
in English
| MEDLINE | ID: covidwho-975063
ABSTRACT
OBJECTIVES:
Efficacy and safety of corticosteroids in patients with 2019-nCoV (novel coronavirus 2019) infection still are debated. Because large randomized clinical trials (RCTs) and a well-conducted meta-analysis on the use of corticosteroids, focused on patients with coronavirus disease (COVID-19) in intensive care units, recently were published, a meta-analysis of RCTs on corticosteroids therapy in patients with different disease severity was performed to evaluate the effect on survival.DESIGN:
A meta-analyses of RCTs was performed.SETTING:
Patients admitted to hospital.PARTICIPANTS:
Patients with coronavirus disease.INTERVENTIONS:
Administration of corticosteroids. MEASUREMENTS AND MAINRESULTS:
A search was performed for RCTs of adult patients with acute hypoxemic failure related to 2019-nCoV infection who received corticosteroids versus any comparator. The primary endpoint was mortality rate. Five RCTs involving 7,692 patients were included. Overall mortality of patients treated with corticosteroids was slightly but significantly lower than mortality of controls (26% v 28%, relative risk {RR}â¯=â¯0.89 [95% confidence interval {CI} 0.82-0.96], pâ¯=â¯0.003). The same beneficial effect was found in the subgroup of patients requiring mechanical ventilation (RRâ¯=â¯0.85 [95% CI 0.72-1.00], pâ¯=â¯0.05 number needed to treat {NNT}â¯=â¯19). Remarkably, corticosteroids increased mortality in the subgroup of patients not requiring oxygen (17% v 13%, RRâ¯=â¯1.23 [95% CI 1.00-1.62], pâ¯=â¯0.05 number needed to harm {NNH}â¯=â¯29). Tests for comparison between mechanically ventilated subgroups and those not requiring oxygen confirmed that treatment with corticosteroids had a statistically significant different effect on survival. Patients treated with corticosteroids had a significantly lower risk of need for mechanical ventilation.CONCLUSIONS:
Corticosteroids may be considered in severe critically ill patients with COVID-19 but must be discouraged in patients not requiring oxygen therapy. Urgently, further trials are warranted before implementing this treatment worldwide.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Adrenal Cortex Hormones
/
COVID-19 Drug Treatment
Type of study:
Experimental Studies
/
Prognostic study
/
Randomized controlled trials
/
Reviews
Limits:
Humans
Language:
English
Journal:
J Cardiothorac Vasc Anesth
Journal subject:
Anesthesiology
/
Cardiology
Year:
2021
Document Type:
Article
Affiliation country:
J.jvca.2020.11.057
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