School of Chemistry and Life Science, Nanjing University Jinling College, Nanjing, China.
Department of Operating Room, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Expert Rev Respir Med. 2022 Jan;16(1):79-89. doi: 10.1080/17476348.2021.1983429. Epub 2021 Sep 30.
To assess the efficacy and safety of corticosteroids in COVID-19 patients compared with standard care or placebo.
Electronic databases were searched to identify relevant studies. The mortality, adverse events, and other data from studies were pooled for statistical analysis.
Ten randomized clinical trials were eligible for inclusion. Corticosteroid treatment in COVID-19 patients did not significantly reduce the risk of death (RR: 0.93; CI: 0.82, 1.05) and the need for mechanical ventilation (RR: 0.82; CI: 0.62, 1.08). No mortality reduction was also observed in the subgroup of patients requiring mechanical ventilation (RR: 0.90; CI: 0.79-1.03). The use of corticosteroids increased mortality in the subgroup of patients not requiring oxygen support (RR: 1.24; CI: 1.00-1.55). The survival benefit was observed in a low dosage of corticosteroids (RR: 0.90; CI: 0.84-0.97) and dexamethasone (RR: 0.90; 95% CI: 0.79-1.04). There was no difference in the rates of adverse events (RR: 1.13; CI: 0.58, 2.20) and secondary infections (RR: 0.87; CI: 0.66, 1.15).
Corticosteroid treatment did not convincingly improve survival in severe COVID-19 patients. Low-dose dexamethasone could be considered as a drug for the treatment of COVID-19 patients. More high-quality trials are needed to further verify this conclusion.: The effect of corticosteroids on patient survival highly depended on the selection of the right dosage and type and in a specific subgroup of patients. This meta-analysis, which included more RCTs, evaluated the safety and efficacy in severe COVID-19 patients and analyzed the effects of different types of corticosteroid treatments. Corticosteroid treatment did not convincingly improve survival in severe COVID-19 patients. But the low dose dexamethasone appear to have a role in the management of severe COVID-19 patients.
评估 COVID-19 患者中皮质类固醇与标准治疗或安慰剂相比的疗效和安全性。
检索电子数据库以确定相关研究。对研究中的死亡率、不良事件和其他数据进行汇总进行统计分析。
有 10 项随机临床试验符合纳入标准。皮质类固醇治疗 COVID-19 患者不能显著降低死亡率（RR：0.93；95%CI：0.82，1.05）和机械通气的需求（RR：0.82；95%CI：0.62，1.08）。在需要机械通气的亚组患者中也没有观察到死亡率降低（RR：0.90；95%CI：0.79-1.03）。皮质类固醇的使用增加了不需要氧气支持的亚组患者的死亡率（RR：1.24；95%CI：1.00-1.55）。在低剂量皮质类固醇（RR：0.90；95%CI：0.84-0.97）和地塞米松（RR：0.90；95%CI：0.79-1.04）中观察到生存获益。不良事件发生率（RR：1.13；95%CI：0.58，2.20）和继发感染率（RR：0.87；95%CI：0.66，1.15）没有差异。
皮质类固醇治疗不能明显改善重症 COVID-19 患者的生存率。低剂量地塞米松可考虑作为 COVID-19 患者的治疗药物。需要更多高质量的试验来进一步验证这一结论。皮质类固醇对患者生存的影响高度取决于正确剂量和类型的选择，以及特定亚组患者的选择。本荟萃分析纳入了更多 RCT，评估了重症 COVID-19 患者的安全性和疗效，并分析了不同类型皮质类固醇治疗的效果。皮质类固醇治疗不能明显改善重症 COVID-19 患者的生存率。但是，低剂量地塞米松似乎在管理重症 COVID-19 患者方面发挥作用。
