Division of Infectious Disease, Mayo Clinic, Rochester, MN.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Chest. 2021 Mar;159(3):1019-1040. doi: 10.1016/j.chest.2020.10.054. Epub 2020 Oct 28.
Since its appearance in late 2019, infections caused by severe acute respiratory syndrome coronavirus 2 have created unprecedented challenges for health systems worldwide. Multiple therapeutic options have been explored, including corticosteroids. Preliminary results of corticosteroids in coronavirus disease 2019 (COVID-19) are encouraging; however, the role of corticosteroids remains controversial.
What is the impact of corticosteroids in mortality, ICU admission, mechanical ventilation, and viral shedding in COVID-19 patients?
We conducted a systematic review of literature on corticosteroids and COVID-19 in major databases (PubMed, MEDLINE, and EMBASE) of published literature through July 22, 2020, that report outcomes of interest in COVID-19 patients receiving corticosteroids with a comparative group.
A total of 73 studies with 21,350 COVID-19 patients were identified. Corticosteroid use was reported widely in mechanically ventilated patients (35.3%), ICU patients (51.3%), and severe COVID-19 patients (40%). Corticosteroids showed mortality benefit in severelly ill COVID-19 patients (OR, 0.65; 95% CI, 0.51-0.83; P = .0006); however, no beneficial or harmful effects were noted among high-dose or low-dose corticosteroid regimens. Emerging evidence shows that low-dose corticosteroids do not have a significant impact in the duration of SARS-CoV-2 viral shedding. The analysis was limited by highly heterogeneous literature for high-dose and low-dose corticosteroids regimens.
Our results showed evidence of mortality benefit in severely ill COVID-19 patients treated with corticosteroids. Corticosteroids are used widely in COVID-19 patients worldwide, and a rapidly developing global pandemic warrants further high-quality clinical trials to define the most beneficial timing and dosing for corticosteroids.
自 2019 年底出现以来，严重急性呼吸综合征冠状病毒 2 引起的感染给全球卫生系统带来了前所未有的挑战。已经探索了多种治疗选择，包括皮质类固醇。皮质类固醇在 2019 年冠状病毒病（COVID-19）中的初步结果令人鼓舞；然而，皮质类固醇的作用仍存在争议。
皮质类固醇对 COVID-19 患者的死亡率、入住 ICU、机械通气和病毒脱落有何影响？
我们对皮质类固醇和 COVID-19 在主要数据库（PubMed、MEDLINE 和 EMBASE）中的文献进行了系统评价，检索时间截至 2020 年 7 月 22 日，报告了接受皮质类固醇治疗的 COVID-19 患者的感兴趣结局，并与对照组进行了比较。
共确定了 73 项研究，涉及 21350 例 COVID-19 患者。皮质类固醇的使用在机械通气患者（35.3%）、ICU 患者（51.3%）和重症 COVID-19 患者（40%）中广泛报道。皮质类固醇对重症 COVID-19 患者的死亡率有益（OR，0.65；95%CI，0.51-0.83；P=0.0006）；然而，高剂量或低剂量皮质类固醇方案均未显示有益或有害作用。新出现的证据表明，低剂量皮质类固醇对 SARS-CoV-2 病毒脱落的持续时间没有显著影响。由于高剂量和低剂量皮质类固醇方案的文献高度异质，分析受到限制。
我们的结果表明，皮质类固醇治疗的重症 COVID-19 患者有死亡获益的证据。皮质类固醇在全球 COVID-19 患者中广泛使用，而迅速发展的全球大流行需要进一步进行高质量的临床试验，以确定皮质类固醇最有益的时机和剂量。
