Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis
BackgroundTo systematically review the literature about the association between systemic corticosteroid therapy (CST) and outcomes of COVID-19 patients. MethodsWe searched Medline, Embase, EBM Reviews, Scopus, Web of Science, and preprints up to July 20, 2020. We included observational studies and r...
محفوظ في:
| المؤلف الرئيسي: | |
|---|---|
| مؤلفون آخرون: | , , , , , , , , |
| التنسيق: | article |
| منشور في: |
2020
|
| الموضوعات: | |
| الوصول للمادة أونلاين: | http://dx.doi.org/10.1016/j.jiph.2020.09.008 https://www.sciencedirect.com/science/article/pii/S1876034120306638 http://hdl.handle.net/10576/44632 |
| الوسوم: |
إضافة وسم
لا توجد وسوم, كن أول من يضع وسما على هذه التسجيلة!
|
| _version_ | 1857415086653571072 |
|---|---|
| author | Haytham, Tlayjeh |
| author2 | Mhish, Olaa H. Enani, Mushira A. Alruwaili, Alya Tleyjeh, Rana Thalib, Lukman Hassett, Leslie Arabi, Yaseen M. Kashour, Tarek Tleyjeh, Imad M. |
| author2_role | author author author author author author author author author |
| author_facet | Haytham, Tlayjeh Mhish, Olaa H. Enani, Mushira A. Alruwaili, Alya Tleyjeh, Rana Thalib, Lukman Hassett, Leslie Arabi, Yaseen M. Kashour, Tarek Tleyjeh, Imad M. |
| author_role | author |
| dc.creator.none.fl_str_mv | Haytham, Tlayjeh Mhish, Olaa H. Enani, Mushira A. Alruwaili, Alya Tleyjeh, Rana Thalib, Lukman Hassett, Leslie Arabi, Yaseen M. Kashour, Tarek Tleyjeh, Imad M. |
| dc.date.none.fl_str_mv | 2020-11-30 2023-06-21T05:41:10Z |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://dx.doi.org/10.1016/j.jiph.2020.09.008 18760341 https://www.sciencedirect.com/science/article/pii/S1876034120306638 http://hdl.handle.net/10576/44632 1652-1663 11 13 |
| dc.language.none.fl_str_mv | en |
| dc.publisher.none.fl_str_mv | Elsevier |
| dc.rights.none.fl_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | COVID-19 Corticosteroids Efficacy Meta-analysis |
| dc.title.none.fl_str_mv | Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis |
| dc.type.none.fl_str_mv | Article info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/article |
| description | BackgroundTo systematically review the literature about the association between systemic corticosteroid therapy (CST) and outcomes of COVID-19 patients. MethodsWe searched Medline, Embase, EBM Reviews, Scopus, Web of Science, and preprints up to July 20, 2020. We included observational studies and randomized controlled trials (RCT) that assessed COVID-19 patients treated with CST. We pooled adjusted effect estimates of mortality and other outcomes using a random effect model, among studies at low or moderate risk for bias. We assessed the certainty of evidence for each outcome using the GRADE approach. ResultsOut of 1067 citations screened for eligibility, one RCT and 19 cohort studies were included (16,977 hospitalized patients). Ten studies (1 RCT and 9 cohorts) with 10,278 patients examined the effect of CST on short term mortality. The pooled adjusted RR was 0.92 (95% CI 0.69–1.22, I2 = 81.94%). This effect was observed across all stages of disease severity. Four cohort studies examined the effect of CST on composite outcome of death, ICU admission and mechanical ventilation need. The pooled adjusted RR was 0.41(0.23−0.73, I2 = 78.69%). Six cohort studies examined the effect of CST on delayed viral clearance. The pooled adjusted RR was 1.47(95% CI 1.11–1.93, I2 = 43.38%). ConclusionIn this systematic review, as of July 2020, heterogeneous and low certainty cumulative evidence based on observational studies and one RCT suggests that CST was not associated with reduction in short-term mortality but possibly with a delay in viral clearance in patients hospitalized with COVID-19 of different severities. However, the discordant results between the single RCT and observational studies as well as the heterogeneity observed across observational studies, call for caution in using observational data and suggests the need for more RCTs to identify the clinical and biochemical characteristics of patients’ population that could benefit from CST. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | qu_5963775da56aa185c63678bbb50e395c |
| identifier_str_mv | 18760341 1652-1663 11 13 |
| language_invalid_str_mv | en |
| network_acronym_str | qu |
| network_name_str | Qatar University repository |
| oai_identifier_str | oai:qspace.qu.edu.qa:10576/44632 |
| publishDate | 2020 |
| publisher.none.fl_str_mv | Elsevier |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| spelling | Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysisHaytham, TlayjehMhish, Olaa H.Enani, Mushira A.Alruwaili, AlyaTleyjeh, RanaThalib, LukmanHassett, LeslieArabi, Yaseen M.Kashour, TarekTleyjeh, Imad M.COVID-19CorticosteroidsEfficacyMeta-analysisBackgroundTo systematically review the literature about the association between systemic corticosteroid therapy (CST) and outcomes of COVID-19 patients. MethodsWe searched Medline, Embase, EBM Reviews, Scopus, Web of Science, and preprints up to July 20, 2020. We included observational studies and randomized controlled trials (RCT) that assessed COVID-19 patients treated with CST. We pooled adjusted effect estimates of mortality and other outcomes using a random effect model, among studies at low or moderate risk for bias. We assessed the certainty of evidence for each outcome using the GRADE approach. ResultsOut of 1067 citations screened for eligibility, one RCT and 19 cohort studies were included (16,977 hospitalized patients). Ten studies (1 RCT and 9 cohorts) with 10,278 patients examined the effect of CST on short term mortality. The pooled adjusted RR was 0.92 (95% CI 0.69–1.22, I2 = 81.94%). This effect was observed across all stages of disease severity. Four cohort studies examined the effect of CST on composite outcome of death, ICU admission and mechanical ventilation need. The pooled adjusted RR was 0.41(0.23−0.73, I2 = 78.69%). Six cohort studies examined the effect of CST on delayed viral clearance. The pooled adjusted RR was 1.47(95% CI 1.11–1.93, I2 = 43.38%). ConclusionIn this systematic review, as of July 2020, heterogeneous and low certainty cumulative evidence based on observational studies and one RCT suggests that CST was not associated with reduction in short-term mortality but possibly with a delay in viral clearance in patients hospitalized with COVID-19 of different severities. However, the discordant results between the single RCT and observational studies as well as the heterogeneity observed across observational studies, call for caution in using observational data and suggests the need for more RCTs to identify the clinical and biochemical characteristics of patients’ population that could benefit from CST.Elsevier2023-06-21T05:41:10Z2020-11-30Articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://dx.doi.org/10.1016/j.jiph.2020.09.00818760341https://www.sciencedirect.com/science/article/pii/S1876034120306638http://hdl.handle.net/10576/446321652-16631113enhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:qspace.qu.edu.qa:10576/446322024-07-23T13:53:40Z |
| spellingShingle | Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis Haytham, Tlayjeh COVID-19 Corticosteroids Efficacy Meta-analysis |
| status_str | publishedVersion |
| title | Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis |
| title_full | Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis |
| title_fullStr | Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis |
| title_full_unstemmed | Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis |
| title_short | Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis |
| title_sort | Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis |
| topic | COVID-19 Corticosteroids Efficacy Meta-analysis |
| url | http://dx.doi.org/10.1016/j.jiph.2020.09.008 https://www.sciencedirect.com/science/article/pii/S1876034120306638 http://hdl.handle.net/10576/44632 |