Department of Hematologic Oncology, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong Province, China.
Department of ICU, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong Province, China.
Leukemia. 2020 Jun;34(6):1503-1511. doi: 10.1038/s41375-020-0848-3. Epub 2020 May 5.
We performed a meta-analysis to determine safety and efficacy of corticosteroids in SARS-CoV-2, SARS-CoV, and MERS-CoV infections. We searched PubMed, Web of Science, Medline, WanFang Chinese database, and ZhiWang Chinese database using Boolean operators and search terms covering SARS-CoV-2, SARS-CoV, OR MERS-CoV AND corticosteroids to find appropriate studies. Review Manager 5.3 was used to analyze results of meta-analysis. Observational studies were analyzed for quality using the modified Newcastle-Ottawa scale and randomized clinical trials, using the Jadad scale. Subjects were divided into those with severe-only and other (severe and not severe) cohorts based on published criteria. Efficacy endpoints studied included mortality, hospitalization duration, rates of intensive care unit (ICU) admission, use of mechanical ventilation, and a composite endpoint (death, ICU admission, or mechanical ventilation). We included 11 reports including 10 cohort studies and 1 randomized clinical trial involving 5249 subjects (2003-2020). Two discussed the association of corticosteroids and virus clearing and 10 explored how corticosteroids impacted mortality, hospitalization duration, use of mechanical ventilation, and a composite endpoint. Corticosteroid use was associated with delayed virus clearing with a mean difference (MD) = 3.78 days (95% confidence Interval [CI] = 1.16, 6.41 days; I = 0%). There was no significant reduction in deaths with relative Risk Ratio (RR) = 1.07 (90% CI = 0.81; 1.42; I = 80%). Hospitalization duration was prolonged and use of mechanical ventilation increased. In conclusion, corticosteroid use in subjects with SARS-CoV-2, SARS-CoV, and MERS-CoV infections delayed virus clearing and did not convincingly improve survival, reduce hospitalization duration or ICU admission rate and/or use of mechanical ventilation. There were several adverse effects. Because of a preponderance of observational studies in the dataset and selection and publication biases our conclusions, especially regarding SARS-CoV-2, need confirmation in a randomized clinical trial. In the interim we suggest caution using corticosteroids in persons with COVID-19.
我们进行了一项荟萃分析，以确定皮质类固醇在 SARS-CoV-2、SARS-CoV 和 MERS-CoV 感染中的安全性和疗效。我们使用布尔运算符和搜索词在 PubMed、Web of Science、Medline、万方中文数据库和知网中文数据库中搜索，涵盖 SARS-CoV-2、SARS-CoV 或 MERS-CoV 和皮质类固醇，以找到合适的研究。使用 Review Manager 5.3 分析荟萃分析结果。使用改良的 Newcastle-Ottawa 量表分析观察性研究的质量，使用 Jadad 量表分析随机临床试验的质量。根据已发表的标准，将受试者分为仅重症组和其他（重症和非重症）组。研究的疗效终点包括死亡率、住院时间、重症监护病房（ICU）入住率、使用机械通气和复合终点（死亡、ICU 入住或机械通气）。我们纳入了 11 份报告，其中包括 10 项队列研究和 1 项随机临床试验，涉及 5249 名受试者（2003-2020 年）。其中 2 项报告讨论了皮质类固醇与病毒清除的关系，10 项报告探讨了皮质类固醇如何影响死亡率、住院时间、机械通气使用和复合终点。皮质类固醇的使用与病毒清除延迟相关，平均差异（MD）=3.78 天（95%置信区间[CI] = 1.16, 6.41 天；I = 0%）。相对风险比（RR）=1.07（90%CI = 0.81；1.42；I = 80%）无显著降低死亡率。住院时间延长，机械通气使用率增加。结论：皮质类固醇在 SARS-CoV-2、SARS-CoV 和 MERS-CoV 感染患者中的使用延迟了病毒清除，并且没有令人信服地改善生存率、缩短住院时间或 ICU 入住率和/或机械通气使用率。皮质类固醇有一些不良反应。由于数据集主要为观察性研究，存在选择和发表偏倚，我们的结论，特别是关于 SARS-CoV-2 的结论，需要在随机临床试验中证实。在这期间，我们建议在 COVID-19 患者中谨慎使用皮质类固醇。
