Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Intensive Care Med. 2021 May;47(5):521-537. doi: 10.1007/s00134-021-06394-2. Epub 2021 Apr 19.
Corticosteroids are now recommended for patients with severe COVID-19 including those with COVID-related ARDS. This has generated renewed interest regarding whether corticosteroids should be used in non-COVID ARDS as well. The objective of this study was to summarize all RCTs examining the use of corticosteroids in ARDS.
The protocol of this study was pre-registered on PROSPERO (CRD42020200659). We searched online databases including MEDLINE, EMBASE, CDC library of COVID research, CINAHL, and COCHRANE. We included RCTs that compared the effect of corticosteroids to placebo or usual care in adult patients with ARDS, including patients with COVID-19. Three reviewers abstracted data independently and in duplicate using a pre-specified standardized form. We assessed individual study risk of bias using the revised Cochrane ROB-2 tool and rated certainty in outcomes using GRADE methodology. We pooled data using a random effects model. The main outcome for this review was 28-day-mortality.
We included 18 RCTs enrolling 2826 patients. The use of corticosteroids probably reduced mortality in patients with ARDS of any etiology (2740 patients in 16 trials, RR 0.82, 95% CI 0.72-0.95, ARR 8.0%, 95% CI 2.2-12.5%, moderate certainty). Patients who received a longer course of corticosteroids (over 7 days) had higher rates of survival compared to a shorter course.
The use of corticosteroids probably reduces mortality in patients with ARDS. This effect was consistent between patients with COVID-19 and non-COVID-19 ARDS, corticosteroid types, and dosage.
皮质类固醇现被推荐用于包括 COVID-19 相关 ARDS 在内的重症 COVID-19 患者。这引发了人们对于皮质类固醇是否也应在非 COVID-19 ARDS 中使用的新兴趣。本研究的目的是总结所有评估皮质类固醇在 ARDS 中应用的 RCT。
本研究方案已在 PROSPERO（CRD42020200659）上预先注册。我们检索了在线数据库，包括 MEDLINE、EMBASE、CDC COVID 研究图书馆、CINAHL 和 COCHRANE。我们纳入了比较皮质类固醇与安慰剂或常规治疗在 ARDS 成人患者（包括 COVID-19 患者）中的疗效的 RCT。三位评审员独立并重复使用预先指定的标准化表格提取数据。我们使用修订后的 Cochrane ROB-2 工具评估单个研究的偏倚风险，并使用 GRADE 方法评估结局的确定性。我们使用随机效应模型汇总数据。本综述的主要结局为 28 天死亡率。
我们纳入了 18 项 RCT，共纳入 2826 例患者。皮质类固醇的使用可能降低了任何病因的 ARDS 患者的死亡率（16 项试验中的 2740 例患者，RR 0.82，95%CI 0.72-0.95，ARR 8.0%，95%CI 2.2-12.5%，中等确定性）。接受较长疗程皮质类固醇（超过 7 天）的患者比接受较短疗程的患者生存率更高。
皮质类固醇的使用可能降低 ARDS 患者的死亡率。这种效果在 COVID-19 和非 COVID-19 ARDS、皮质类固醇类型和剂量之间是一致的。
