Systemic administration of glucocorticoids, cardiovascular complications and mortality in patients hospitalised with COVID-19, SARS, MERS or influenza: A systematic review and meta-analysis of randomised trials

Abstract

Background Administration of glucocorticoids might reduce mortality in patients with severe COVID-19 but have adverse cardiometabolic effects. Objectives to investigate the effect of systemic administration of glucocorticoids on cardiovascular complications and all-cause mortality in patients hospitalised with respiratory viral infections, including COVID-19, SARS, MERS and influenza. Methods We identified randomised trials published prior to July 28th, 2021. The Mantel-Haenszel random effects method and the Hartung and Knapp adjustment were used to obtain pooled estimates of treatment effect with 95% confidence intervals. Results No randomised trials of glucocorticoids for SARS, MERS or influenza reported relevant outcomes. We included eleven COVID-19 randomised trials (8,109 patients).Overall, compared to placebo or standard care, glucocorticoids were not associated with a reduction of in-hospital mortality (p=0.09). In a pre-specified sub-analysis, in-hospital mortality was reduced by 19% when follow-up was restricted to 14 days from randomisation (5/11 trials, 1,329 patients, p=0.02). With longer follow-up (9/11 trials, 7,874 patients), administration of glucocorticoids was associated with a trend to benefit for those requiring mechanical ventilation (RR 0.86; 95% CI 0.57-1.27) but possible harm for those not receiving oxygen at randomisation (RR 1.27; 95% CI 1.00 – 1.61), an effect that was significantly different amongst subgroups (p = 0.0359). Glucocorticoids reduced the risk of worsening renal function by 37% (4/11 trials); reported rate of other cardiovascular complications was low. Conclusions Administration of systemic glucocorticoids to patients hospitalised with COVID-19 does not lower mortality overall but may reduce it in those requiring respiratory support and increase it in those who do not.

Impact of COVID-19 on Cardiovascular Disease

“…Mechanisms underlying these beneficial cardiac effects of corticosteroids in COVID-19 patients may include stabilization of the vascular endothelial barrier, which may attenuate perturbations of the cardiac microcirculation, as well as systemic and cardiac anti-inflammatory effects [ 182 ]. Furthermore, a meta-analysis including RCTs evaluating the effect of glucocorticoids in the setting of COVID-19 found that glucocorticoids had no influence on CV events [ 183 ]. Thus, based on the limited amount of data available to date, individual risk assessment before applying corticosteroids, taking into account both the severity of COVID-19 and the presence of HF, may help to optimize the treatment decision and clinical outcome in HF patients.…”

Could the fibromyalgia syndrome be triggered or enhanced by COVID-19?

“…Corticosteroids are among the drugs recommended to manage patients with COVID-19 and are widely used for treating other diseases closely related to COVID, such as Severe Acute Respiratory Syndrome and Middle Eastern Respiratory Syndrome (Caiazzo et al 2022 ). This drug class inhibits many inflammation-associated molecules, such as cytokines (IL-6, IFN-γ, and TNF-α), chemokines, arachidonic acid metabolites, and adhesion molecules, besides up-regulating anti-inflammatory mediators (Barnes 2011 ).…”

Cardiovascular Complications in Coronavirus Disease 2019—Pathogenesis and Management

“…Therefore, prior use of corticosteroids was not associated with improved outcomes in hospitalized COVID-19 patients. 69…”

“…Therefore, prior use of corticosteroids was not associated with improved outcomes in hospitalized COVID-19 patients. 69 During the acute phase, the use of systemic corticosteroids was shown to decrease mortality according to the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial, particularly among those patients requiring oxygen therapy. The effect of corticosteroids on cardiovascular complications was assessed in a meta-analysis that found no evidence of beneficial effects in regarding cardiac arrest or ventricular arrhythmias (RR, 1.41; 95% CI, 0.11-18.05), other arrhythmias (RR, 0.83; 95% CI, 0.59-1.16), MI (RR, 0.49; 95% CI, 0.04-5.35) and deep vein thrombosis or pulmonary embolism (RR, 0.53; 95% CI, 0.03-8.77).…”