Zeng Yiqian, Zeng Weizhong, Yang Bihui, Liu Zhao
Department of Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, Hunan, China.
Department of Hematology, Zhuzhou Central Hospital, Zhuzhou, Hunan, China.
Med Clin (Engl Ed). 2022 Dec 23;159(12):575-583. doi: 10.1016/j.medcle.2022.03.020. Epub 2022 Dec 15.
Currently, corticosteroids are widely used to treat coronavirus disease 2019 (COVID-19) symptoms. However, the therapeutic role of corticosteroids remains highly controversial. To that end, we aimed to assess the efficacy of corticosteroids in treating COVID-19 patients.
We searched PubMed, Embase, and Cochrane Library to select suitable studies. Our primary study endpoint was all-cause mortality. The secondary study endpoint was the length of hospital stay.
A total of 9 randomized controlled trials (RCTs) with 7907 patients were assessed. The pooled result indicated that corticosteroids treatment could significantly reduce all-cause mortality in patients with COVID-19 (RR = 0.88, 95% CI [0.82, 0.95], = 0.002). When subgroup analyses were performed, we found that corticosteroids were associated with decreased all-cause mortality in severe COVID-19 patients (RR = 0.77, 95% CI [0.68, 0.88], < 0.0001), however no obvious difference was observed in all-cause mortality of non-severe COVID-19 patients between the corticosteroid and control group (RR = 0.96, 95% CI [0.86, 1.06], = 0.41), meanwhile, a low dose (RR = 0.89, 95% CI [0.82, 0.97], = 0.007) of dexamethasone (RR = 0.9, 95% CI [0.83, 0.98], = 0.01) with a long treatment course (RR = 0.89, 95% CI [0.82, 0.98], = 0.02) was beneficial for all-cause mortality in COVID-19 patients. Additionally, we found that corticosteroids might be associated with a longer length of hospital stay in non-severe COVID-19 patients (MD = 3.83, 95% CI [1.11, 6.56], = 0.006).
Our results showed that corticosteroid therapy was related to a reduction in all-cause mortality in severe COVID-19 patients. However, in patients with non-severe COVID-19, the use of corticosteroids did not decrease all-cause mortality and may prolong the duration of hospital stay. In addition, we revealed that a low dose of dexamethasone with a long treatment course could reduce all-cause mortality in COVID-19 patients.
目前，皮质类固醇被广泛用于治疗2019冠状病毒病（COVID-19）症状。然而，皮质类固醇的治疗作用仍存在高度争议。为此，我们旨在评估皮质类固醇治疗COVID-19患者的疗效。
我们检索了PubMed、Embase和Cochrane图书馆以选择合适的研究。我们的主要研究终点是全因死亡率。次要研究终点是住院时间。
共评估了9项随机对照试验（RCT），涉及7907例患者。汇总结果表明，皮质类固醇治疗可显著降低COVID-19患者的全因死亡率（RR = 0.88，95%CI [0.82，0.95]，P = 0.002）。进行亚组分析时，我们发现皮质类固醇与重症COVID-19患者全因死亡率降低相关（RR = 0.77，95%CI [0.68，0.88]，P < 0.0001），然而，皮质类固醇组与对照组相比，非重症COVID-19患者的全因死亡率无明显差异（RR = 0.96，95%CI [0.86，1.06]，P = 0.41），同时，低剂量（RR = 0.89，95%CI [0.82，0.97]，P = 0.007）的地塞米松（RR = 0.9，95%CI [0.83，0.98]，P = 0.01）和长疗程治疗（RR = 0.89，95%CI [0.82，0.98]，P = 0.02）对COVID-19患者的全因死亡率有益。此外，我们发现皮质类固醇可能与非重症COVID-19患者住院时间延长有关（MD = 3.83，95%CI [1.11，6.56]，P = 0.006）。
我们的结果表明，皮质类固醇治疗与重症COVID-19患者全因死亡率降低有关。然而，在非重症COVID-19患者中，使用皮质类固醇并未降低全因死亡率，且可能延长住院时间。此外，我们发现低剂量地塞米松长疗程治疗可降低COVID-19患者的全因死亡率。
