Comparison of Associations Between Glucocorticoids Treatment and Mortality in COVID-19 Patients and SARS Patients: A Systematic Review and Meta-Analysis

Abstract

BackgroundThe response to glucocorticoids treatment may be different between Covid-19 and SARS. MethodsIn this systematic review and meta-analysis, we searched studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, ClinicalTrials.gov, ICTRP from 2002 to October 7, 2020. We used fixed-effects and random-effects models to compute the risk ratio of death in the group receiving glucocorticoids treatment and the control group for COVID-19 and SARS, respectively.ResultsTen trials and 71 observational studies, with a total of 45935 patients, were identified. Glucocorticoids treatment, was associated with decreased all-cause mortality both in COVID-19 (risk ratio, 0.88; 95% confidence interval, 0.82 to 0.94; I2=26%) and SARS (0.48; 0.29 to 0.79; 10%), based on high quality evidence, as well as decreased all-cause mortality-including composite outcome of COVID-19 (0.89; 0.82 to 0.98; 0%). In subgroup analyses, all-cause mortality was significantly lower among COVID-19 patients being accompanied by severe ARDS but not mild ARDS, taking low-dose or pulse glucocorticoids, being critically severe but not only severe, being of critical severity and old but not young, being of critical severity and men but not women, non-early taking glucocorticoids and taking dexamethasone or methylprednisolone; but for SARS, lower mortality were observed among those who were taking medium-high dose glucocorticoids, being severe or critically severe, early taking glucocorticoids, and taking dexamethasone or prednisolone. ConclusionsGlucocorticoids treatment reduced mortality in COVID-19 and SARS patients of critical severity; however, different curative effects existed between the two diseases among subpopulations, mainly regarding sex- and age-specific effects, optimal doses and use timing of glucocorticoids.

Beyond vaccination: A Cross-Sectional Study of the importance of Behavioral and Native Factors on COVID-19 Infection and Severity

“…A higher need for intensive care increase by age among individuals older than 45 years [133]. Our findings only confirm the importance of this factor by going in the same direction as previous reviews and meta-analysis studies [134,135].…”

Early initiation of corticosteroids in patients hospitalized with COVID-19 not requiring intensive respiratory support: cohort study

“…1 Recent meta-analyses and observational studies have also reported greater benefit of corticosteroids in severe compared to more mild acute respiratory distress syndrome (ARDS). 7,9 However, these studies did not stratify patients further by level of respiratory support during the initial 48 hours of hospitalization, separating those who did and did not require IRS. Instead, clinical guidelines such as those issued by the National Institutes of Health recommend initiation of corticosteroids in hospitalized COVID-19 patients "on oxygen," without further distinguishing between low-flow NC and forms of IRS.…”

“…In several viral pneumonias, corticosteroids were associated with greater risk of harm, [21][22][23] although they appeared beneficial in the original severe acute respiratory syndrome. 7,24 The net balance between benefit and harm of corticosteroids for pneumonia is not well understood and likely depends on multiple factors, including patient characteristics, heterogeneity in host response to infection, etiology of pneumonia, and time since onset of infection and ARDS. [25][26][27][28] While corticosteroids may decrease host inflammatory response with potential modulating effects to lung injury, they may also have harmful side effects or unintended consequences on adaptive immune responses that may be important to resolution of infection.…”

“…Some studies investigating the association between corticosteroids and outcomes among a wider group of patients with COVID-19 -including a larger proportion not on IRS than in the RECOVERY trial -have found mixed results. [6][7][8][9][10] Variability may be due to host factors including immune response to infection, heterogeneity in severity of illness and level of respiratory support, duration of infection, and use of different formulations of corticosteroids 8 as well as residual confounding in observational studies. However, the findings may also suggest that certain subgroups of patients with COVID-19 benefit less from corticosteroids.…”

Dexamethasone in hospitalised COVID-19 patients not on intensive respiratory support

“…The association between corticosteroids and outcomes among a wider group of patients with COVID-19including a larger proportion without IRS than in the RECOVERY trialhas been mixed. [7][8][9][10][11] Variability in the effect of corticosteroids may be due to numerous factors. A recent Cochrane review concluded that systemic corticosteroids "probably reduce allcause mortality slightly" but that there is an "urgent need for good-quality evidence for specific subgroups of disease severity, for which we propose level of respiratory support at randomization."…”