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COVID-19 患者中类固醇的使用:一项荟萃分析。

Use of steroids in COVID-19 patients: A meta-analysis.

机构信息

Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, 226002, India.

Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, 226002, India; Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, 226002, India.

出版信息

Eur J Pharmacol. 2022 Jan 5;914:174579. doi: 10.1016/j.ejphar.2021.174579. Epub 2021 Oct 19.


DOI:10.1016/j.ejphar.2021.174579
PMID:34678244
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8525014/
Abstract

BACKGROUND: Emerging reports have shown the benefits of steroids in hospitalized COVID-19 patients as life-saving drugs. However, the use of steroids in COVID-19 patients is confusing among many physicians. AIM: The aim of the current study was to find out the exact association of steroids in the deaths of COVID-19 patients. METHODS: The relevant studies were searched in PubMed, Google scholar, and Clinical trials registries till May 25, 2021 and sorted out based on inclusion and exclusion criteria. The quality of studies was assessed using a standard scale. The pooled odds ratio was calculated with a 95% confidence interval. The sensitivity and sub-group analyses were also done. The publication bias was assessed qualitatively. The Rev Man 5 was used for all analyses with a random-effect model. RESULTS: The quantitative analysis was done with 9922 patients (6265-male and 3657-females) from 21 relevant studies. The pooled estimate results i.e. 0.52 [0.34, 0.80] have shown a significant reduction in deaths of COVID-19 patients in the steroidal group as compared to the non-steroidal group. The sensitivity analyses did not alter our conclusions. In subgroup analysis, methylprednisolone has shown a significant reduction in deaths of COVID-19 patients as compared to the non-steroidal group, however, more clinical evidence is required for dexamethasone and hydrocortisone. CONCLUSION: The use of steroids in hospitalized COVID-19 patients is useful to reduce deaths.

摘要

背景:有新报告显示,类固醇在住院的 COVID-19 患者中是一种有救命作用的药物。然而,许多医生在 COVID-19 患者中使用类固醇的方法仍存在困惑。

目的:本研究旨在确定类固醇与 COVID-19 患者死亡的确切关联。

方法:我们在 PubMed、Google Scholar 和临床试验注册中心检索了截至 2021 年 5 月 25 日的相关研究,并根据纳入和排除标准对其进行了筛选。使用标准量表评估研究质量。使用 95%置信区间计算合并优势比。还进行了敏感性和亚组分析。定性评估发表偏倚。使用 Rev Man 5 进行所有分析,并采用随机效应模型。

结果:对 21 项相关研究中的 9922 名患者(6265 名男性和 3657 名女性)进行了定量分析。合并估计结果为 0.52 [0.34, 0.80],表明类固醇组 COVID-19 患者的死亡率明显低于非类固醇组。敏感性分析并未改变我们的结论。在亚组分析中,与非类固醇组相比,甲泼尼龙可显著降低 COVID-19 患者的死亡率,然而,还需要更多的临床证据来证实地塞米松和氢化可的松的效果。

结论:在住院的 COVID-19 患者中使用类固醇有助于降低死亡率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/0380615427fd/gr7_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/61cd0cea19fb/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/915a02a1edf6/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/89aab01389d5/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/0ee0a322f9f5/gr4_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/3752a69b1c95/gr5_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/7da8b7baba95/gr6_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/0380615427fd/gr7_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/61cd0cea19fb/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/915a02a1edf6/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/89aab01389d5/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/0ee0a322f9f5/gr4_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/3752a69b1c95/gr5_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/7da8b7baba95/gr6_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5fc/8525014/0380615427fd/gr7_lrg.jpg

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本文引用的文献

[1]
Janus kinase inhibitors and major COVID-19 outcomes: time to forget the two faces of Janus! A meta-analysis of randomized controlled trials.

Clin Rheumatol. 2021-11

[2]
Coronavirus disease-2019: A review on the disease exacerbation via cytokine storm and concurrent management.

Int Immunopharmacol. 2021-10

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Theranostics. 2021

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Brief Bioinform. 2021-11-5

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Monocyte-driven atypical cytokine storm and aberrant neutrophil activation as key mediators of COVID-19 disease severity.

Nat Commun. 2021-7-5

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Do Anti-androgens Have Potential as Therapeutics for COVID-19?

Endocrinology. 2021-8-1

[7]
Corticosteroid therapy for COVID-19: A systematic review and meta-analysis of randomized controlled trials.

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[8]
Short term survival of critically ill COVID-19 Egyptian patients on assisted ventilation treated by either Dexamethasone or Tocilizumab.

Sci Rep. 2021-4-23

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The proportion and effect of corticosteroid therapy in patients with COVID-19 infection: A systematic review and meta-analysis.

PLoS One. 2021

[10]
Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis.

Intensive Care Med. 2021-5

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