Department of Pharmacology, L. M. College of Pharmacy, Ahmedabad, Gujarat, India.
Rev Med Virol. 2022 Sep;32(5):e2386. doi: 10.1002/rmv.2386. Epub 2022 Aug 15.
The effect of corticosteroid therapy is still controversial on prevention of mortality in coronavirus disease-2019 (COVID-19). The objective of this study is to investigate the effect of corticosteroids on mortality. This systematic review was performed as per preferred reporting items for systematic reviews and meta-analyses guidelines. A systematic search was performed at different databases namely Medline/PubMed, Cochrane and Google scholar on 10 February 2022. A pooled estimate for effect of corticosteroid therapy on mortality was calculated as outcome of study. Risk bias analysis and Newcastle Ottawa Scale were used to assess the quality of randomized control trial (RCT) and cohort studies, respectively. Cochran's Q test and the I statistic were conducted for heterogeneity and accordingly study model was applied. A total 43 studies were included, having sample size of 96,852 patients. Amongst them, 19,426 and 77,426 patients received corticosteroid therapy (intervention group) or standard treatment without corticosteroid (control group), respectively. Mortality observed in the intervention and control group was 14.2% (2749) and 7.1% (5459), respectively. The pooled estimate 2.173 (95% CI: 2.0690-2.2820) showed significantly increased mortality in intervention as compared to control. The pooled estimate of methyprednisolone 1.206 (95% CI: 1.0770-1.3500) showed significantly increased mortality while the pooled estimate of dexamethasone 1.040 (95% CI: 0.9459-1.1440) showed insignificantly increased mortality as compared to control. In conclusion, corticosteroid therapy produced a negative prognosis as depicted by increased mortality among COVID-19 patients. The possible reasons might be delay in virus clearance and secondary infections due to corticosteroids initiated at high dose in the early stage of infection.
皮质类固醇治疗对预防 2019 年冠状病毒病（COVID-19）患者的死亡率的效果仍存在争议。本研究旨在探讨皮质类固醇对死亡率的影响。本系统评价按照系统评价和荟萃分析指南的首选报告项目进行。于 2022 年 2 月 10 日在不同数据库（即 Medline/PubMed、Cochrane 和 Google Scholar）进行了系统检索。计算皮质类固醇治疗对死亡率的影响作为研究结果的汇总估计。风险偏倚分析和纽卡斯尔-渥太华量表分别用于评估随机对照试验（RCT）和队列研究的质量。采用 Cochran's Q 检验和 I 统计量进行异质性分析，并相应地应用研究模型。共纳入 43 项研究，样本量为 96852 例患者。其中，19426 例和 77426 例患者分别接受皮质类固醇治疗（干预组）或不使用皮质类固醇的标准治疗（对照组）。干预组和对照组的死亡率分别为 14.2%（2749）和 7.1%（5459）。汇总估计值 2.173（95%CI：2.0690-2.2820）表明，与对照组相比，干预组的死亡率显著增加。甲泼尼龙的汇总估计值 1.206（95%CI：1.0770-1.3500）显示死亡率显著增加，而地塞米松的汇总估计值 1.040（95%CI：0.9459-1.1440）显示死亡率与对照组相比无显著增加。总之，皮质类固醇治疗对 COVID-19 患者产生了负面预后，表现为死亡率增加。可能的原因是由于在感染早期高剂量开始使用皮质类固醇导致病毒清除延迟和继发感染。
