Department of Pharmacology, PGIMER, Chandigarh, India.
Department of Ophthalmology, GMCH-32, Chandigarh, India.
Indian J Pharmacol. 2020 Nov-Dec;52(6):535-550. doi: 10.4103/ijp.ijp_1146_20.
Although the use of steroids in the management of COVID-19 has been addressed by a few systematic review and meta-analysis, however, they also used data from "SARS-CoV" and "MERS-CoV." Again, most of these studies addressed only one severity category of patients or addressed only one efficacy endpoint (mortality). In this context, we conducted this meta-analysis to evaluate the efficacy and safety of steroid therapy among all severity categories of patients with COVID-19 (mild to moderate and severe to critical category) in terms of "mortality," "requirement of mechanical ventilation," "requirement of ICU" and clinical cure parameters.
11 databases were screened. Only randomized controlled trials (RCTs) or high quality (on the basis of risk of bias analysis) comparative-observational studies were included in the analysis. RevMan5.3 was used for the meta-analysis.
A total of 15 studies (3 RCT and 12 comparative-observational studies) were included. In the mechanically-ventilated COVID-19 population, treatment with dexamethasone showed significant protection against mortality (single study). Among severe and critically ill combined population, steroid administration was significantly associated with lowered mortality (risk ratio [RR] 0.83 [0.76-0.910]), lowered requirement of mechanical ventilation (RR 0.59 [0.51-0.69]), decreased requirement of intensive care unit (ICU) (RR 0.62 [0.45-0.86]), lowered length of ICU stay (single-study) and decreased duration of mechanical ventilation (two-studies). In mild to moderate population, steroid treatment was associated with a higher "duration of hospital stay," while no difference was seen in other domains. In patients at risk of progression to "acute respiratory distress syndrome," steroid administration was associated with "reduced requirement of mechanical ventilation" (single-study).
This study guides the use of steroid across patients with different severity categories of COVID-19. Among mechanically ventilated patients, steroid therapy may be beneficial in terms of reduced mortality. Among "severe and critical" patients; steroid therapy was associated with lowered mortality, decreased requirement of mechanical ventilation, and ICU. However, no benefit was observed in "mild to moderate" population. To conclude, among properly selected patient populations (based-upon clinical severity and biomarker status), steroid administration may prove beneficial in patients with COVID-19.
尽管有一些系统评价和荟萃分析已经探讨了在 COVID-19 管理中使用类固醇的问题，但它们也使用了来自“严重急性呼吸综合征冠状病毒”（SARS-CoV）和“中东呼吸综合征冠状病毒”（MERS-CoV）的数据。同样，这些研究大多数仅针对患者的一种严重程度类别，或者仅针对一个疗效终点（死亡率）进行了研究。在这种情况下，我们进行了这项荟萃分析，以评估在 COVID-19 所有严重程度类别（轻症至中症和重症至危重症）的患者中，类固醇治疗在“死亡率”、“需要机械通气”、“需要重症监护病房（ICU）”和临床治愈参数方面的疗效和安全性。
筛选了 11 个数据库。仅纳入随机对照试验（RCT）或高质量（基于偏倚风险分析）的对照观察性研究进行分析。使用 RevMan5.3 进行荟萃分析。
共纳入 15 项研究（3 项 RCT 和 12 项对照观察性研究）。在接受机械通气的 COVID-19 患者中，地塞米松治疗显著降低死亡率（单项研究）。在重症和危重症患者中，类固醇治疗与降低死亡率相关（风险比[RR]0.83[0.76-0.910]）、降低机械通气需求（RR0.59[0.51-0.69]）、降低 ICU 需求（RR0.62[0.45-0.86]）、缩短 ICU 住院时间（单项研究）和缩短机械通气时间（两项研究）。在轻症至中症患者中，类固醇治疗与“住院时间延长”有关，而在其他方面没有差异。在有进展为“急性呼吸窘迫综合征”风险的患者中，类固醇治疗与“降低机械通气需求”相关（单项研究）。
本研究指导了不同严重程度类别 COVID-19 患者使用类固醇。在接受机械通气的患者中，类固醇治疗可能有助于降低死亡率。在“重症和危重症”患者中，类固醇治疗与降低死亡率、降低机械通气需求和 ICU 需求相关。然而，在“轻症至中症”患者中未观察到获益。总之，在适当选择的患者人群（基于临床严重程度和生物标志物状态）中，类固醇治疗可能对 COVID-19 患者有益。
