Systemic Corticosteroid Administration in Coronavirus Disease 2019 Outcomes: An Umbrella Meta-Analysis Incorporating Both Mild and Pulmonary Fibrosis–Manifested Severe Disease

Abstract

Background: Effective treatments for coronavirus disease 2019 (COVID-19) are urgently needed. The real role of corticosteroid use in COVID-19 has long been of interest and is disputable.Methods: We aimed to quantitatively reevaluate the efficacy of corticosteroids on COVID-19. Databases were searched for eligible meta-analyses/systematic reviews with available outcome data. For each association, we estimated the summary effect size with fixed- and random-effects models, 95% confidence intervals, and 95% prediction intervals. Heterogeneity, Egger’s test, evidence of small-study effects and excess significance bias, and subgroup analyses were rigorously evaluated.Results: Intended outcomes of 12 eligible studies were mortality, clinical improvement, hospitalization, mechanical ventilation (MV), adverse events (AEs), intensive care unit (ICU) stay, hospital stay, virus clearance time (VCT), and negative conversion. Corticosteroid administration was associated with a 27% risk reduction in MV [hazard ratio (HR): 0.73 (0.64–0.83)] and a 20% reduction in mortality of critically ill/severe COVID-19 patients [HR: 0.80 (0.65–0.98)]. Interestingly, shorter ICU stays and, conversely, potentially longer hospital stays, a longer VCT, and a longer time to negative conversion were associated with corticosteroid use. There was no significant impact of different corticosteroid doses on mortality. Only one study showed slightly excess significant bias. Caution should be applied given the weak nature of the evidence, and it has been confirmed by sensitivity analyses too.Conclusion: This umbrella study found benefits from corticosteroids on MV and especially the mortality of critically ill/severe patients with shorter ICU stays but prolonged hospital stays and VCT. The benefits and harms should be reevaluated and balanced before corticosteroids are cautiously prescribed in clinical practice.

Risk of Coronavirus Disease 2019–Associated Pulmonary Aspergillosis Based on Corticosteroid Duration in Intensive Care Patients

“…Inpatient corticosteroid duration of >15 days has been associated with a higher risk of CAPA [ 8 ]. Systematic reviews and meta-analyses have found that long-term corticosteroid use prior to hospital admission is a relevant risk factor for CAPA [ 18 , 19 ]. However, many studies included did not specify doses or total duration of corticosteroids received [ 18 , 19 ].…”

“…Systematic reviews and meta-analyses have found that long-term corticosteroid use prior to hospital admission is a relevant risk factor for CAPA [ 18 , 19 ]. However, many studies included did not specify doses or total duration of corticosteroids received [ 18 , 19 ]. We aimed to evaluate the risk of CAPA with typical COVID-19 corticosteroid treatment durations (≤10 days) and prolonged durations (>10 days).…”

SARS-CoV-2 infection of human lung epithelial cells induces TMPRSS-mediated acute fibrin deposition

“…Since none of the healthy nor recovered BALF showed fibrin clot formation, it suggests that the presence of activated thrombin in C3263 BALF is related to the SARS-CoV-2 infection in the patient. The clinical risk of developing pulmonary pathology associated with COVID has not been well characterized, although preexisting pulmonary conditions, severity of infection and the presence of inflammatory factors appear to predict the risk of COVID-associated lung damage [61][62][63][64][65][66] . Our findings suggest the concentrations of prothrombin, fibrinogen and other coagulation factors in SARS-CoV-2 infected lung fluids may be used to indicate the risk of COVID-associated lung pathology.…”

Comparison of standard dose with high dose of methylprednisolone in the management of COVID-19 patients admitted in ICU

“…Cheng B, et al . [ 20 ] also concluded that SD of corticosteroid administration was associated with a 27% risk reduction in mechanical ventilation (hazard ratio [HR]: 0.73 [0.64–0.83]) and a 20% reduction in the mortality of critically ill/severe COVID-19 patients (HR: 0.80 [0.65–0.98]).…”