Cheng Wenwen, Li Yufeng, Cui Liyan, Chen Ying, Shan Sharui, Xiao Duan, Chen Xiaoyun, Chen Zhuoming, Xu Anding
Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Front Pharmacol. 2020 Sep 9;11:571156. doi: 10.3389/fphar.2020.571156. eCollection 2020.
COVID-19 is a type of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that was identified in December 2019. Corticosteroid therapy was empirically used for clinical treatment in the early stage of the disease outbreak; however, data regarding its efficacy and safety are controversial. The aim of this study was to evaluate the efficacy and safety of corticosteroid therapy in patients with COVID-19.
The PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and China Science and Technology Journal (VIP) databases were searched for studies. Data on clinical improvement, mortality, virus clearance time, adverse events (AEs), utilization of mechanical ventilation, length of intensive care unit (ICU) hospitalization, and hospital stay were extracted by two authors independently. Study quality was assessed by the Newcastle Ottawa Scale (cohort studies). The pooled data were meta-analyzed using a random effects model, and the quality of evidence was rated using the GRADE approach.
Eleven cohort studies (corticosteroid group vs control group), two retrospective cohort studies (without control group), and seven case studies were identified. A total of 2840 patients were included. Compared with the control treatments, corticosteroid therapy was associated with clinical recovery (RR = 1.30, 95% CI [0.98, 1.72]) and a significantly shortened length of ICU hospitalization (RR = -6.50; 95% CI [-7.63 to -5.37]), but it did not affect the mortality ((RR = 1.59; 95% CI [0.69-3.66], = 93.5%), utilization of mechanical ventilation (RR = 0.35; 95% CI [0.10, 1.18]), duration of symptoms (WMD = 1.69; 95% CI [-0.24 to 3.62]) or virus clearance time (RR = 1.01; 95% CI [-0.91 to 2.92], = 57%) in COVID-19 patients. Treatment with corticosteroids in patients with COVID-19 may cause mild adverse outcomes. The quality of evidence was low or very low for all outcomes.
The findings of our study indicate that corticosteroid therapy is not highly effective, but it appears to improve prognosis and promote clinical recovery in patients with severe COVID-19.
2019年12月发现的新型冠状病毒肺炎（COVID-19）是由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染引起的一种肺炎。在疾病爆发初期，皮质类固醇疗法被经验性地用于临床治疗；然而，关于其疗效和安全性的数据存在争议。本研究的目的是评估皮质类固醇疗法对COVID-19患者的疗效和安全性。
检索了PubMed、Cochrane图书馆、EMBASE、科学引文索引（Web of Science）、中国知网（CNKI）、万方和维普数据库中的研究。由两位作者独立提取关于临床改善、死亡率、病毒清除时间、不良事件（AE）、机械通气的使用、重症监护病房（ICU）住院时间和住院时间的数据。采用纽卡斯尔渥太华量表（队列研究）评估研究质量。使用随机效应模型对汇总数据进行荟萃分析，并采用GRADE方法对证据质量进行评级。
确定了11项队列研究（皮质类固醇组与对照组）、2项回顾性队列研究（无对照组）和7项病例研究。共纳入2840例患者。与对照治疗相比，皮质类固醇疗法与临床恢复相关（RR = 1.30，95%CI [0.98, 1.72]），ICU住院时间显著缩短（RR = -6.50；95%CI [-7.63至-5.37]），但不影响死亡率（（RR = 1.59；95%CI [0.69 - 3.66]，I² = 93.5%）、机械通气的使用（RR = 0.35；95%CI [0.10, 1.18]）、症状持续时间（WMD = 1.69；95%CI [-0.24至3.62]）或COVID-19患者的病毒清除时间（RR = 1.01；95%CI [-0.9从原文看，此处疑似有误，应为-0.91至2.92]），I² = 57%）。COVID-19患者使用皮质类固醇治疗可能会导致轻度不良后果。所有结局的证据质量均为低或极低。
我们的研究结果表明，皮质类固醇疗法并非非常有效，但似乎可以改善重症COVID-19患者的预后并促进临床恢复。 1至2.92]，I² = 57%）。COVID-19患者使用皮质类固醇治疗可能会导致轻度不良后果。所有结局的证据质量均为低或极低。
我们的研究结果表明，皮质类固醇疗法并非非常有效，但似乎可以改善重症COVID-19患者的预后并促进临床恢复。
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