Effect of corticosteroid treatment on 1376 hospitalized COVID-19 patients. A cohort study.

Albani, Filippo; Fusina, Federica; Granato, Enza; Capotosto, Cristina; Ceracchi, Claudia; Gargaruti, Riccardo; Santangelo, Giovanni; Schiavone, Luca; Taranto, Maria; Tosati, Cinzia; Vavassori, Elena; Natalini, Giuseppe

doi:10.1101/2020.07.17.20155994

Cited by 8 publications

(18 citation statements)

References 37 publications

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“…Similarly, in a cohort of 1376 patients, Albani et al 29 have also echoed that corticosteroids do not affect the mortality in hospitalized patients with COVID‐19.…”

Section: Discussionmentioning

confidence: 93%

Are the steroids a blanket solution for COVID‐19? A systematic review and meta‐analysis

Sarkar

Khanna

Soni

2020

Journal of Medical Virology

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Steroids may play a critical role in the current pandemic of coronavirus disease‐2019 (COVID‐19), given the dearth of specific therapeutic options. This review was conducted to evaluate the impact of glucocorticoid therapy in patients with COVID‐19 based on the publications reported to date. A comprehensive screening was conducted using electronic databases up to August 19, 2020. The randomized controlled trials (RCTs) and cohort studies evaluating the effectiveness and safety of steroids in patients with COVID‐19 are included for the meta‐analyses. Our search retrieved twelve studies, including two RCTs and 10 cohort studies, with a total of 15,754 patients. In patients with COVID‐19, the use of systemic glucocorticoid neither reduce mortality (odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.11–3.4, I2 = 96%), nor the duration of hospital stay (mean difference [MD] = 1.18 days, 95% CI: −1.28 to 3.64, I2 = 93%) and period of viral shedding (MD = 1.42 days, 95% CI: −0.52 to 3.37, I2 = 0%). Systemic steroid therapy may not be effective for reducing mortality, duration of hospitalization, and period of viral shedding. Studies are mostly heterogeneous. Further RCTs are required.

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“…Similarly, in a cohort of 1376 patients, Albani et al 29 have also echoed that corticosteroids do not affect the mortality in hospitalized patients with COVID‐19.…”

Section: Discussionmentioning

confidence: 93%

Are the steroids a blanket solution for COVID‐19? A systematic review and meta‐analysis

Sarkar

Khanna

Soni

2020

Journal of Medical Virology

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“…As of July 20, a total of 24 studies (1 RCT, 23 cohorts) [ [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] ], including single center and multicenter studies from different countries, were identified in our systematic review. Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies (1 RCT, 9 cohorts) [ 26 , 31 , 33 , 35 , 37 , 39 , 42 , 46 , 49 ] examined the effect of CST on short-term mortality in hospitalized patients with COVID-19. The pooled adjusted RR was 0.91 (95% CI 0.71–1.16, I 2 = 82.23%) indicating no significant association between CST and mortality ( Fig.…”

Section: Resultsmentioning

confidence: 99%

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Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis

Tlayjeh

Mhish

Enani

et al. 2020

Journal of Infection and Public Health

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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, I 2 = 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, I 2 = 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, I 2 = 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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“…For example, in April 2020, guidelines from the Infectious Diseases Society of America issued a weak recommendation against corticosteroids, except for patients with COVID-19 and ARDS treated in the context of a clinical trial [3]. During the main phase of the pandemic in Europe (March to June 2020), only evidence from small observational studies, with contrasting results, was available [4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Association between corticosteroids and intubation or death among patients with COVID-19 pneumonia in non-ICU settings: an observational study using of real-world data from 51 hospitals in France and Luxembourg

Tran¹,

Mahévas

Sadr

et al. 2020

Preprint

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Objective To assess the effectiveness of corticosteroids on outcomes of patients with mild COVID-19 pneumonia. Methods We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) vs standard of care (no-CTC group) among patients ≤ 80 years old with COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death at Day 28. Baseline characteristics of patients were balanced using propensity score inverse probability of treatment weighting. Results Among the 891 patients included in the analysis, 203 were assigned to the CTC group. At day 28, corticosteroids did not reduce the rate of the primary outcome (wHR 0.92, 95% CI 0.61 to 1.39) nor the cumulative death rate (wHR 1.03, 95% CI 0.54 to 1.98). Corticosteroids significantly reduced the rate of the primary outcome for patients requiring oxygen ≥ at 3L/min (wHR 0.50, 95% CI 0.30 to 0.85) or C-Reactive Protein (CRP) ≥ 100mg/L (wHR 0.44, 95%CI 0.23 to 0.85). We found a higher number of hyperglycaemia events among patients who received corticosteroids, but number of infections were similar across the two groups. Conclusions We found no association between the use of corticosteroids and intubation or death in the broad population of patients ≤80 years old with COVID-19 hospitalized in non-ICU settings. However, the treatment was beneficial for patients with ≥ 3L/min oxygen or CRP ≥ 100mg/L at baseline. These data support the need to confirm the right timing of corticosteroids for patients with mild COVID.

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Effect of corticosteroid treatment on 1376 hospitalized COVID-19 patients. A cohort study.

Cited by 8 publications

References 37 publications

Are the steroids a blanket solution for COVID‐19? A systematic review and meta‐analysis

Are the steroids a blanket solution for COVID‐19? A systematic review and meta‐analysis

Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis

Association between corticosteroids and intubation or death among patients with COVID-19 pneumonia in non-ICU settings: an observational study using of real-world data from 51 hospitals in France and Luxembourg

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