Medical Service Center, Gansu Provincial Hospital, Lanzhou, China.
Geriatric Respiratory Department, First Hospital of Lanzhou University, Lanzhou, China.
Front Public Health. 2022 Jul 22;10:847695. doi: 10.3389/fpubh.2022.847695. eCollection 2022.
During the ongoing coronavirus disease 2019 (COVID-19) pandemic, the use of corticosteroids for COVID-19 has ignited worldwide debate. Previous systematic reviews, including randomized controlled trials (RCTs) and retrospective observational studies, found that corticosteroids have beneficial effects in treating COVID-19.
This systematic review and meta-analysis only included RCTs to assess the effectiveness and safety of corticosteroids in hospitalized patients with COVID-19.
Comprehensive research strategies (PubMed, Embase, MEDLINE, and Coherence Library) were used to search for RCTs from December 2019 to January 2021.
Five RCTs were included with 7,235 patients, of which 2,508 patients were receiving corticosteroid treatments (dexamethasone or methylprednisolone), and 4,727 received standard care. The primary outcome was mortality within 28 days. The use of corticosteroids decreased the 28-day mortality of patients with COVID-19, but the findings were not statistically significant (RR, 0.91; 95% CI, 0.78-1.06, = 0.24). The secondary outcome was the duration of hospitalization; no differences were found between the corticosteroid and standard care groups. However, corticosteroids were associated with a higher hospital discharge rate than standard treatment, but the result was not statistically significant (RR, 1.36; 95% CI, 0.95-1.96, = 0.09).
The results suggest that corticosteroids are comparable to standard care in terms of safety in treating COVID-19. Corticosteroids showed greater efficacy than standard care; however, the effect was minimal.
在持续的 2019 冠状病毒病（COVID-19）大流行期间，皮质类固醇在 COVID-19 中的应用引发了全球范围内的争论。之前的系统评价，包括随机对照试验（RCT）和回顾性观察性研究，发现皮质类固醇在治疗 COVID-19 方面具有有益作用。
本系统评价和荟萃分析仅纳入 RCT，以评估皮质类固醇在 COVID-19 住院患者中的疗效和安全性。
采用全面的研究策略（PubMed、Embase、MEDLINE 和 Coherence Library）检索 2019 年 12 月至 2021 年 1 月的 RCT。
纳入了 5 项 RCT，共 7235 例患者，其中 2508 例接受皮质类固醇治疗（地塞米松或甲基强的松龙），4727 例接受标准治疗。主要结局是 28 天内的死亡率。皮质类固醇降低了 COVID-19 患者的 28 天死亡率，但无统计学意义（RR，0.91；95%CI，0.78-1.06， = 0.24）。次要结局是住院时间；皮质类固醇组和标准治疗组之间无差异。然而，皮质类固醇组的出院率高于标准治疗组，但差异无统计学意义（RR，1.36；95%CI，0.95-1.96， = 0.09）。
结果表明，皮质类固醇在 COVID-19 治疗的安全性方面与标准治疗相当。皮质类固醇的疗效优于标准治疗，但效果甚微。
