Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
Sci Rep. 2020 Dec 1;10(1):20935. doi: 10.1038/s41598-020-78054-2.
The World Health Organization (WHO) has published guidance recommending systemic corticosteroids for the treatment of patients with severe or critical COVID-19 and no corticosteroids for those with nonsevere COVID-19. Although their recommendations for critical cases were based on the results from seven randomized controlled trials (RCTs), those for noncritical cases were based on the results from only one RCT, the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial. In search of additional evidence of corticosteroids' effect on COVID-19, we systematically reviewed controlled observational studies, besides RCTs, that assessed the impact of corticosteroid treatment on any type of mortality and/or other outcomes in noncritical patients. Of the 4037 titles and abstracts screened, we ultimately included the RECOVERY trial and five controlled observational studies using propensity score matching, (accessed on September 8, 2020). Two of the controlled observational studies assessed the association between corticosteroid treatment and in-hospital mortality, without finding statistical significance. Four of the controlled observational studies assessed corticosteroids' effect on other outcomes, demonstrating that they were associated with reduced risk of intubation in patients requiring oxygen and with longer hospitalization and viral shedding in mild or moderate cases. These results support the WHO recommendations not to use corticosteroids for nonsevere COVID-19.
世界卫生组织（WHO）发布了指南，建议对患有严重或危急 COVID-19 的患者使用全身性皮质类固醇治疗，对非严重 COVID-19 患者则不使用皮质类固醇。尽管他们对危急病例的建议是基于 7 项随机对照试验（RCT）的结果，但对非危急病例的建议仅基于一项 RCT（RECOVERY 试验）的结果。为了寻找皮质类固醇对 COVID-19 影响的其他证据，我们系统地综述了除 RCT 以外的对照观察性研究，评估皮质类固醇治疗对非危急患者任何类型死亡率和/或其他结局的影响。在筛选出的 4037 篇标题和摘要中，我们最终纳入了 RECOVERY 试验和使用倾向评分匹配的 5 项对照观察性研究（检索日期：2020 年 9 月 8 日）。其中两项对照观察性研究评估了皮质类固醇治疗与住院死亡率之间的关系，未发现统计学意义。四项对照观察性研究评估了皮质类固醇对其他结局的影响，表明皮质类固醇治疗与需要吸氧的患者的插管风险降低以及轻度或中度病例的住院时间延长和病毒脱落有关。这些结果支持 WHO 对非严重 COVID-19 不使用皮质类固醇的建议。
