Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China.
Molecular Medicine Research Center, State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China.
BMC Infect Dis. 2021 Oct 14;21(1):1063. doi: 10.1186/s12879-021-06548-z.
Evidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear.
In this systematic review and meta-analysis, we searched for studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, and ClinicalTrials.gov from 2019 to April 20, 2021. We mainly pooled the risk ratios (RRs) and mean difference (MD) for viral clearance delay and did subgroup analyses by the severity of illness and doses of glucocorticoids.
38 studies with a total of 9572 patients were identified. Glucocorticoids treatment was associated with delayed viral clearance in COVID-19 patients (adjusted RR 1.52, 95% CI 1.29 to 1.80, I = 52%), based on moderate-quality evidence. In subgroup analyses, risk of viral clearance delay was significant both for COVID-19 patients being mild or moderate ill (adjusted RR 1.86, 95% CI 1.35 to 2.57, I = 48%), and for patients of being severe or critical ill (adjusted RR 1.59, 95% CI 1.23 to 2.07, I = 0%); however, this risk significantly increased for patients taking high doses (unadjusted RR 1.85, 95% CI 1.08 to 3.18; MD 7.19, 95% CI 2.78 to 11.61) or medium doses (adjusted RR 1.86, 95% CI 0.96 to 3.62, I = 45%; MD 3.98, 95% CI 3.07 to 4.88, I = 4%), rather those taking low doses (adjusted RR 1.38, 95% CI 0.94 to 2.02, I = 59%; MD 1.46, 95% CI -0.79 to 3.70, I = 82%).
Glucocorticoids treatment delayed viral clearance in COVID-19 patients of taking high doses or medium doses, rather in those of taking low doses of glucocorticoids.
糖皮质激素是否会延迟 COVID-19 患者的病毒清除尚无定论。
本系统评价和荟萃分析检索了 2019 年至 2021 年 4 月 20 日期间 Medline、Embase、EBSCO、ScienceDirect、Web of Science、Cochrane 图书馆和 ClinicalTrials.gov 中的研究。我们主要汇总了病毒清除延迟的风险比（RR）和均数差（MD），并按疾病严重程度和糖皮质激素剂量进行了亚组分析。
共纳入 38 项研究，总计 9572 例患者。糖皮质激素治疗与 COVID-19 患者的病毒清除延迟相关（调整 RR 1.52，95% CI 1.29-1.80，I=52%），证据质量为中等级别。在亚组分析中，轻中度疾病患者（调整 RR 1.86，95% CI 1.35-2.57，I=48%）和重度或危重症患者（调整 RR 1.59，95% CI 1.23-2.07，I=0%）发生病毒清除延迟的风险均有统计学意义；然而，高剂量（未调整 RR 1.85，95% CI 1.08-3.18；MD 7.19，95% CI 2.78-11.61）或中剂量（调整 RR 1.86，95% CI 0.96-3.62，I=45%；MD 3.98，95% CI 3.07-4.88，I=45%）患者的这种风险显著增加，而低剂量（调整 RR 1.38，95% CI 0.94-2.02，I=59%；MD 1.46，95% CI -0.79-3.70，I=82%）患者则无此风险。
高剂量或中剂量糖皮质激素治疗会延迟 COVID-19 患者的病毒清除，而非低剂量糖皮质激素治疗。
