Effect of Corticosteroids therapy on mortality in the COVID-19 patients- A systematic review and Meta-analysis (preprint)

ABSTRACT

Background: and Purpose: Corticosteroid therapy is still controversial to use for treatment of coronavirus disease-2019 (COVID-19). The results of multiple randomized clinical trials (RCTs) and observational studies are very diverse and contradictory, which arising difficulty in the clinical decision-making. The objective of this study is to investigate the effect of corticosteroids on mortality by systematic review and meta-analysis. External Approach: A systematic search was performed on different databases namely Medline/PubMed, Cochrane and Google scholar on 10 February 2022, according to PRISMA guidelines. The 28-days mortality was considered as outcome of study. A pooled estimate was calculated with random effects and fixed effects models. Cochran’s Q test and the I2 statistic were conducted for statistical heterogeneity. Key Results: 38 studies were included, having sample size of 87,781 patients. Amongst them, 16437 patients received corticosteroid therapy (intervention group) while 71344 patients were standard (noncorticosteroids) therapy (control group). 12.68% (2084) mortality observed in the intervention group while 5.93% (4227) mortality observed in the control group. The overall pooled estimate showed a significantly (OR2.305;95%CI 2.1810 to 2.4370) increased mortality in intervention group. A pooled fold change estimation showed significantly increased in the mortality in methylprednisolone (OR 1.206;95%CI 1.0770 to 1.3500) and dexamethasone (OR 1.388;95% CI1.1870 to 1.6220) therapy. Conclusion and Implication In conclusion, corticosteroid therapy produced a negative prognosis as depicted by increased mortality among COVID-19 patients. The possible reasons might be delay in virus clearance and secondary infection due to initiation of the corticosteroids at high dose in the early stage of infection.