This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research
Tongwen Sun
Zhengzhou University First Affiliated Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6536-3222
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: We conducted a comprehensive literature review to synthesize evidence for the relationship between corticosteroid use and mortality in COVID-19 patients.
Methods: The PUBMED, EMBASE, and Cochrane Library were searched from inception to March 13, 2021. We searched and analyzed randomized controlled trials (RCTs) and observational studies (OS) that examined the corticosteroid use in COVID-19 patients. The primary outcome was in-hospital mortality, while the secondary outcome was the need for mechanical ventilation (MV) and serious adverse events.
Results: 11 RCTs and 46 OS involving 7,893 and 4,1696 COVID-19 patients were included in the study. Corticosteroid use was associated with lower COVID-19 mortality in RCTs, but was not statistically significant (OR, 0.88; 95% CI, 0.74–1.05; I2=66.9%). The subgroup analysis of severe COVID-19 patients, corticosteroid type and dose also showed no survival benefit statistically. However, the corticosteroid use may reduce the MV need (OR, 0.67; 95% CI, 0.51–0.90; I2=7.5%) with no significant increase in serious adverse reactions (OR, 0.84; 95% CI, 0.30–2.37; I2=33.3%). In addition, the included OS showed that the pulse dose (OR, 0.52; 95% CI, 0.39–0.70) and methylprednisolone use (OR, 0.69; 95% CI, 0.52–0.92; I2=66.7%) may lower the mortality in COVID-19 patients.
Conclusions: This meta-analysis indicated that corticosteroid use might cause a slight reduction in COVID-19 mortality. However, it could significantly reduce the MV requirement in COVID-19 patients and restrict serious adverse events. Additionally, the pulse dose of methylprednisolone may be a good treatment choice for COVID-19 patients.
Keywords
corticosteroid use, COVID-19, mortality, MV, adverse events, meta-analysis
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
- FigureS1.tif
Figure S1. Bias risk evaluation tool of included RCTs. Red represents high-risk bias, green circles represent low-risk bias, and yellow circles mean unclear risk of bias.
- FigureS2.tif
Figure S2. A forest plot showing the association between corticosteroid use and COVID-19 mortality in OS using the random-effects model.
- FigureS3.tif
Figure S3. A forest plot showing the association between low or high dose corticosteroid use and COVID-19 mortality in RCTs using the random-effects model. Figure S3. A forest plot showing the association between corticosteroid use and severe adverse events in RCTs using the random-effects model.
- FigureS4.tif
Figure S4. A forest plot showing the association between corticosteroid use and severe COVID-19 mortality in RCTs using the random-effects model.
- FigureS5.tif
Figure S5. A forest plot showing the association between corticosteroid use and severe COVID-19 mortality in OS using the random-effects model.
- FigureS6.tif
Figure S6. A forest plot showing the association between low or high dose corticosteroid use and COVID-19 mortality in RCTs using the random-effects model.
- FigureS7.tif
Figure S7. A forest plot showing the association between different types of corticosteroid use and COVID-19 mortality in RCTs using the random-effects model.
- FigureS8.tif
Figure S8. The sensitivity analysis of included RCTs and OS. A represents the sensitivity analysis of RCTs; B represents the sensitivity analysis of OS.
- FigureS9.tif
Figure S9. The funnel plots of included RCTs and OS. A represents the funnel plot of RCTs; B represents the funnel plot of OS.
- TableS1.doc
Table S1. PRISMA 2009 checklist.
- TableS2.docx
Table S2. Specific retrieval strategy.
- TableS3.Asummaryofincludedobservationalstudies..docx
Table S3. A summary of included observational studies.
- TableS4.TheNOSofidentifiedobservationalstudies..docx
Table S4. The NOS of identified observational studies.
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Tongwen Sun
Zhengzhou University First Affiliated Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6536-3222
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 17 May, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: We conducted a comprehensive literature review to synthesize evidence for the relationship between corticosteroid use and mortality in COVID-19 patients.
Methods: The PUBMED, EMBASE, and Cochrane Library were searched from inception to March 13, 2021. We searched and analyzed randomized controlled trials (RCTs) and observational studies (OS) that examined the corticosteroid use in COVID-19 patients. The primary outcome was in-hospital mortality, while the secondary outcome was the need for mechanical ventilation (MV) and serious adverse events.
Results: 11 RCTs and 46 OS involving 7,893 and 4,1696 COVID-19 patients were included in the study. Corticosteroid use was associated with lower COVID-19 mortality in RCTs, but was not statistically significant (OR, 0.88; 95% CI, 0.74–1.05; I2=66.9%). The subgroup analysis of severe COVID-19 patients, corticosteroid type and dose also showed no survival benefit statistically. However, the corticosteroid use may reduce the MV need (OR, 0.67; 95% CI, 0.51–0.90; I2=7.5%) with no significant increase in serious adverse reactions (OR, 0.84; 95% CI, 0.30–2.37; I2=33.3%). In addition, the included OS showed that the pulse dose (OR, 0.52; 95% CI, 0.39–0.70) and methylprednisolone use (OR, 0.69; 95% CI, 0.52–0.92; I2=66.7%) may lower the mortality in COVID-19 patients.
Conclusions: This meta-analysis indicated that corticosteroid use might cause a slight reduction in COVID-19 mortality. However, it could significantly reduce the MV requirement in COVID-19 patients and restrict serious adverse events. Additionally, the pulse dose of methylprednisolone may be a good treatment choice for COVID-19 patients.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
- FigureS1.tif
Figure S1. Bias risk evaluation tool of included RCTs. Red represents high-risk bias, green circles represent low-risk bias, and yellow circles mean unclear risk of bias.
- FigureS2.tif
Figure S2. A forest plot showing the association between corticosteroid use and COVID-19 mortality in OS using the random-effects model.
- FigureS3.tif
Figure S3. A forest plot showing the association between low or high dose corticosteroid use and COVID-19 mortality in RCTs using the random-effects model. Figure S3. A forest plot showing the association between corticosteroid use and severe adverse events in RCTs using the random-effects model.
- FigureS4.tif
Figure S4. A forest plot showing the association between corticosteroid use and severe COVID-19 mortality in RCTs using the random-effects model.
- FigureS5.tif
Figure S5. A forest plot showing the association between corticosteroid use and severe COVID-19 mortality in OS using the random-effects model.
- FigureS6.tif
Figure S6. A forest plot showing the association between low or high dose corticosteroid use and COVID-19 mortality in RCTs using the random-effects model.
- FigureS7.tif
Figure S7. A forest plot showing the association between different types of corticosteroid use and COVID-19 mortality in RCTs using the random-effects model.
- FigureS8.tif
Figure S8. The sensitivity analysis of included RCTs and OS. A represents the sensitivity analysis of RCTs; B represents the sensitivity analysis of OS.
- FigureS9.tif
Figure S9. The funnel plots of included RCTs and OS. A represents the funnel plot of RCTs; B represents the funnel plot of OS.
- TableS1.doc
Table S1. PRISMA 2009 checklist.
- TableS2.docx
Table S2. Specific retrieval strategy.
- TableS3.Asummaryofincludedobservationalstudies..docx
Table S3. A summary of included observational studies.
- TableS4.TheNOSofidentifiedobservationalstudies..docx
Table S4. The NOS of identified observational studies.
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