Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature

Veronese, Nicola; Demurtas, Jacopo; Yang, Lin; Tonelli, Roberto; Barbagallo, Mario; Lopalco, Pierluigi; Lagolio, Erik; Celotto, Stefano; Pizzol, Damiano; Zou, Liye; Tully, Mark A.; Ilie, Petre Cristian; Trott, Mike; Sánchez, Guillermo Felipe López; Smıth, Lee

doi:10.3389/fmed.2020.00170

Cited by 159 publications

(157 citation statements)

References 35 publications

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“…One aspect that caught our attention is that, despite our hospital being the reference center for Oncology in our province, the number of cancer patients infected with COVID-19 was relatively low. It might be that the corticosteroids often prescribed for the treatment of these patients offered some protection, as some studies have suggested [32] or perhaps these patients were more careful than the general population during confinement, which unfortunately cannot be proven. Having said that, the relationship between cancer and the mortality of our patients was evident.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with mortality in hospitalized patients with SARS-CoV-2 infection. A prospective, longitudinal, unicenter study in Reus, Spain

Iftimie

López‐Azcona

Vicente-Miralles

et al. 2020

Preprint

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20Spain is one of the countries that has suffered the most from the impact of severe acute 21 respiratory syndrome coronavirus 2 (SARS-CoV-2), the strain that causes coronavirus disease 22 2019 (COVID-19). However, there is a lack of information on the characteristics of this disease in 23 the Spanish population. The objective of this study has been to characterize our patients from 24 an epidemiological point of view and to identify the risk factors associated with mortality in our 25 geographical area. We performed a prospective, longitudinal study on 188 hospitalized cases of 26 SARS-Cov-2 infection in Hospital Universitari de Sant Joan, in Reus, Spain, admitted between 27 15 th March 2020 and 30 th April 2020. We recorded demographic data, signs and symptoms and 28 comorbidities. We also calculated the Charlson and McCabe indices. A total of 43 deaths 29 occurred during the study period. Deceased patients were older than the survivors (77.7 ± 13.1 30 vs. 62.8 ± 18.4 years; p < 0.001). Logistic regression analyses showed that fever, pneumonia, 31 acute respiratory distress syndrome, diabetes mellitus and cancer were the variables that 32 showed independent and statistically significant associations with mortality. The Charlson index 33 was more efficient than the McCabe index in discriminating between deceased and survivors. 34 This is one of the first studies to describe the factors associated with mortality in patients 35 infected with SARS-CoV-2 in Spain, and one of the few in the Mediterranean area. We identified 36 the main factors independently associated with mortality in our population. Further studies in 37 are needed to complete and confirm our findings. 38 39 40 41

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Section: Discussionmentioning

confidence: 99%

Risk factors associated with mortality in hospitalized patients with SARS-CoV-2 infection. A prospective, longitudinal, unicenter study in Reus, Spain

Iftimie

López‐Azcona

Vicente-Miralles

et al. 2020

Preprint

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“…Furthermore, with the high publication rate of COVID-19 studies in the past months, it is important to include peer reviewed studies from which it is also possible to quantify a potential effect of corticosteroids and this was not the case in some earlier reviews. [16,17] Our conclusions are also different as research into other serious coronavirus infections (SARS-CoV and MERS) discouraged the administration of steroids because of unconvincing survival improvement and side effects such as hyperglycemia, higher bacterial infection rate, delayed viral clearance. [2,18,19,56] Our review has several limitations.…”

Section: Discussionmentioning

confidence: 87%

“…studies reported the effect of corticosteroids on viral RNA clearance. In 5/22 studies, time to viral clearance was not in uenced by methylprednisolone treatment:Xu et al (adjusted OR 1.38, 95% CI 0.52-3.65, p=0.519), Fang et al (18.8 ± 5.3 vs. 18.3 ± 4.2 days, p=0.84), Shi et al (adjusted HR 1.00 (0.53-1.89), p=0.990), Liu et al (10.0 ± 5.3 days vs. 10.0 ± 7.9 days, p>0.05), and Zha et al (15 (14-16) days vs. 14(11)(12)(13)(14)(15)(16)(17) days, p=0.87) [39,44,47,49,51]. Four studies found that corticosteroids delayed viral clearance, i.e.Ling et al (15 days vs. 8.0 days in pharyngeal swab, p= 0.013), Gong et al (29.11 ± 6.61 days vs. 24.44 ± 5.21 days, p=0.03), Chen et al (adjusted HR 0.60 (0.39-0.94), p=0.024), and Shen et al (18 days vs. 13 days, p=0.003), although Shen et al only observed delay in blood samples, not in oropharyngeal swabs.…”

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confidence: 91%

“…The use of corticosteroids, however, is controversial because of known adverse effects such as delayed viral clearance, opportunistic infections and suppression of the hypothalamic-pituary-adrenal axis. [2,16,17] Earlier studies done in MERS-CoV and SARS-CoV showed delayed viral clearance, opportunistic infections and hyperglycemia. [18][19][20] Thus, until recently (June 25th 2020), both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) did not recommend the routine use of systemic corticosteroids in COVID-19 patients.…”

Section: Introductionmentioning

confidence: 99%

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Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

Hoekstra

Neumann

Boot

et al. 2020

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Background In the current SARS-CoV-2 pandemic, there has been worldwide debate on the use of corticosteroids in COVID-19. In a recent RCT (RECOVERY trial), a reduced 28-day mortality in patients requiring oxygen therapy or mechanical ventilation evaluating the effect of dexamethasone was shown. Their results have led to considering amendments in guidelines or actually already recommending corticosteroid use in COVID-19. However, the supposed effect of corticosteroids on mortality and viral clearance remains unclear and a clear evidence-based therapeutic strategy is still lacking.Objectives The aim of this systematic review and meta-analysis was to evaluate the effect of corticosteroids on mortality, viral clearance and secondary outcomes in COVID-19 patients.Data source, study eligibility, participants, interventionsA systematic literature search was performed across Medline/PubMed, Embase, and Web of Science from 1st of December 2019 until 10th of July 2020, according to the PRISMA guidelines. RCTs and cohort studies reporting in English, on ≥15 adult COVID-19 patients, treated with any type of corticosteroid therapy were included. Studies on pregnant women, reviews and with a NOS (Newcastle Ottawa Scale for validity assessment of observational studies) score of ≤4 were excluded.Results Twenty-two articles were included, covering 9,760 patients. In eight studies, the effect of corticosteroid use was quantified. The pooled estimate of the observational studies supported the positive effect on mortality of corticosteroid therapy in COVID-19 as reported in the RECOVERY trial, in respiratory compromised COVID-19 patients, i.e. oxygen or mechanical ventilation dependent or with ARDS. The overall pooled estimate (observational studies and the RCT) showed reduced mortality in the corticosteroid group (relative risk 0.55 [95% CI 0.27-0.83]). Furthermore, mechanical ventilation rate seemed lower in corticosteroid treated COVID-19 patients, though no definite conclusions could be drawn because of a low number of studies. With regard to potential side effects of corticosteroids, the effect on viral clearance duration was ambiguous, i.e. prolonged in 4 of 9 and without effect in 5 of 9 studies.Conclusions It appears safe with respect to viral clearance to administer corticosteroids in respiratory compromised COVID-19 patients with possible improvement in mortality and conflicting effects on viral clearance.

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“…Cytokine storm extensively damages vascular endothelium and alveolar epithelium which increases vascular permeability leading to pulmonary edema and hyaline formation [19,20], similar to our ndings previous studies also reported aggravation of symptoms during 5-7 days after the disease onset [21], therefore it is important to control the in ammatory response and cytokine storm in this phase, however, by the systematic review, Nicola Veronese concluded that the routine use of corticosteroids in COVID-19 couldn't be encouraged, but methylprednisolone therapy could lower mortality rate in more severe forms of this condition, such as in severe respiratory failure. [22] So with the assumption of an immune-mediated incident, in moderate to severe patients, we started using high dose steroid pulse therapy with 1000 mg methylprednisolone sodium succinate for three days, which continued with oral prednisolone (1 mg/kg), while tapering the dose within seven days. The general condition of all patients receiving methylprednisolone pulse was signi cantly improved as none of them didn't need for mechanical ventilation, and they were dischargeable from ICU after ten days of receiving corticosteroid.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Efficacy of Methylprednisolone Pulse Therapy in Treatment of Covid-19 Adult Patients with Severe Respiratory Failure: Randomized, Clinical Trial

Farahani

Mosaed

Nezami-Asl

et al. 2020

Preprint

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Background: Covid-19 is now global concern and widely spread to the world due to high mortality among the nations we tried to evaluate the efficacy of methylprednisolone pulse in COVID-19 patients with severe respiratory failure.Methods: This study was phase2, double-blind, randomized, clinical trial in adults with COVID-19 (aged ≥18 years old) admitted to the intensive care unit (ICU) of *. Patients with intermediate or severe COVID-19 with PaO2/FiO2 less than 300 and progressive disease unresponsive to standard treatments admitted to ICU. Patients were randomly allocated in either control or investigation group. The control group received recommended regimen for COVID-19. The investigation group received the recommended regimen plus Methylprednisolone (1000mg/day for three days) and oral prednisolone 1mg/kg with tapering of dose within ten days. Results: A total of 29 ICU patients with intermediate or severe COVID-19 pneumonia recruited in this study. Fourteen patients (4 female, ten male) allocated in the investigation group, and 15 patients (6 female, nine male) assigned to the control group. The participant’s average age was 64.03±13.545 (case: 61.07±12.83, control: 66.80±14.03). The patients with methylprednisolone pulse had significantly higher systolic (P=0.018) and diastolic (P=0.001) blood pressure, meanwhile, the Glasgow coma scale (GCS) of methylprednisolone group was considerably (P<0.001) higher, and by the improvement in SpO2 of methylprednisolone group none of these patients needed mechanical ventilation.Conclusion: This study demonstrated methylprednisolone pulse in COVID-19 severe respiratory failure dramatically improves the clinical condition of patients including, GCS, and SpO2 of patients.Clinical Trial Registration Number: IRCT20200406046963N1

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Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature

Cited by 159 publications

References 35 publications

Risk factors associated with mortality in hospitalized patients with SARS-CoV-2 infection. A prospective, longitudinal, unicenter study in Reus, Spain

Risk factors associated with mortality in hospitalized patients with SARS-CoV-2 infection. A prospective, longitudinal, unicenter study in Reus, Spain

Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes

Evaluation of the Efficacy of Methylprednisolone Pulse Therapy in Treatment of Covid-19 Adult Patients with Severe Respiratory Failure: Randomized, Clinical Trial

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