|
Author
|
Reference
|
Study type
|
Type - dose γ
corticosteroids
|
Sample size
|
CoVID - Study population
|
Reporting outcome α
|
Quality score ẟ (Risk of bias or NOS)
|
Main findings
|
M
|
V
|
H
|
R
|
O
|
I
|
1
|
Angus
|
34
|
REMAPt β
|
Hydrocortisone < 1 mg/kg ED
|
403
|
ICU patients
|
x
|
|
x
|
x
|
|
|
Risk of Biasẟ
|
Two hydorcoritsone dosing resulted high probabilities of superiority with regard to the odds of improvement in organ support–free days within 21 days, compared to standard of care
|
2
|
Bani-Sadr
|
39
|
Cohort with historical controls
|
Prednisolone or Methylprednisolone > 1 mg/kg ED
|
319
|
Hospitalized patients
|
x
|
|
|
|
x
|
x
|
4
|
Addition of corticosteroids to our institution’s COVID-19 treatment
protocol was associated with a significant reduction in hospital mortality in the ‘after’ period
|
3
|
Cao
|
80
|
Retrospective Observational
|
Unknown
|
102
|
Hospitalized patients
|
x
|
|
|
|
|
|
5
|
Patient characteristics seen more frequently in those who died were development of systemic complications following onset of the illness and the severity of disease requiring admission to the ICU.
|
4
|
Chen Zu
|
|
Retrospective Observational
|
Unknown
|
267
|
Hospitalized patients
|
x
|
x
|
|
|
|
|
7
|
Corticosteroid treatment is associated with prolonged viral RNA shedding and should be used with caution.
|
5
|
Chroboczek
|
72
|
Retrospective Observational
|
Unknown
|
70
|
Hospitalized patients
|
|
|
|
x
|
|
|
6
|
Corticosteroids therapy affected the risk of intubation with a risk difference of −47.1% (95% CI −71.8 to −22.5).
|
6
|
Dequin
|
35
|
Randomized controlled trial
|
Methylprednisolone or Hydrocortisone < 1 mg/kg ED
|
149
|
ICU patients with respiratory failure
|
x
|
|
|
x
|
x
|
x
|
Risk of Biasẟ
|
Low dose hydrocortisone, compared with placebo, did not significantly reduce treatment failure (defined as death or persistent respiratory support) at day 21 in critically ill patients.
|
7
|
Fadel
|
38
|
Quasi Experimental
|
Methylprednisolone > 1 mg/kg ED
|
213
|
Moderate to severe CoVID patients
|
x
|
|
x
|
x
|
|
|
6
|
An early short course of methylprednisolone in patients with moderate to severe COVID-19 reduced escalation of care and improved clinical outcomes
|
8
|
Fang Mei
|
40
|
Retrospective Observational
|
Methylprednisolone < 1 mg/kg ED
|
78
|
Hospitalized patients
|
|
x
|
|
|
|
|
5
|
Low-dose corticosteroid therapy may not delay viral clearance in patients with COVID-19.
|
9
|
Feng Ling
|
66
|
Retrospective Observational
|
Unknown
|
476
|
Hospitalized patients
|
x
|
|
x
|
|
|
|
5
|
Differences in AT II receptor inhibitors use were associated with different severities of disease. Multiple lung lobes involvement and pleural effusion were associated with the severity of COVID-19. Advanced age (>75 yr) was a risk factor for mortality.
|
10
|
Fernandez
|
41
|
Retrospective Observational
|
Methylprednisolone > 1 mg/kg ED
|
463
|
Patients with ARDS hyperinflammation
|
x
|
|
|
|
x
|
|
5
|
Glucocorticoid use is associated with increased survival and improved mortality rates in Severe CoVID-19 patients.
|
11
|
Gazzaruso
|
42
|
Retrospective Observational
|
Methylprednisolone or Prednisone < 1 mg/kg ED
|
219
|
Hospitalized patients
|
x
|
|
|
|
x
|
|
3
|
Anti-rheumatic drugs, probably steroids included, may modulate inflammation and avoid a hyperinflammation that leads to severe complications and death in subjects with COVID-19.
|
12
|
Gong Guan
|
43
|
Retrospective Observational
|
Methylprednisolone > 1 mg/kg ED
|
34
|
Hospitalized Patients < 50 years
|
|
x
|
|
|
x
|
|
6
|
Corticosteroids therapy can effectively release COVID‐19 symptoms, improve oxygenation, and prevent disease progression. However, it can prolong the negative conversion of nucleic acids.
|
13
|
Horby
|
23
|
Randomized controlled trial
|
Dexamethasone < 1 mg/kg ED
|
6425
|
Hospitalized patients
|
x
|
|
x
|
x
|
|
|
Risk of Biasẟ
|
The use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.
|
15
|
Hu Wang
|
44
|
Retrospective Observational
|
Prednisolone or Methylprednisolone
> 1 mg/kg ED
|
308
|
Hospitalized patients
|
x
|
x
|
|
|
|
|
4
|
Glucocorticoid therapy did not significantly influence the outcomes nor the adverse events of COVID-19 pneumonia
|
16
|
Huang Song
|
45
|
Retrospective Observational
|
Methylprednisolone 2 study- groups: High: > 1 mg/kg ED Low: < 1mg/kg ED
|
64
|
Hospitalized patients
|
x
|
|
|
|
|
|
4
|
There were no significant differences in the duration of severe illness or the number of days on high level respiratory support between low dose and high dose methylprednisolone group. The mean number of days in the hospital was higher in the high dose group
|
14
|
Huang Yang
|
81
|
Retrospective Observational
|
Unknown
|
60
|
Severe CoVID patients
|
|
|
|
|
|
x
|
5
|
There were no statistically significant differences in immunoglobulin therapy and GCs therapy between the improvement and deterioration subgroups.
|
17
|
Jeronimo
|
36
|
Randomized controlled trial
|
Methylprednisolone < 1 mg/kg ED
|
393
|
Hospitalized patients
|
x
|
|
x
|
x
|
|
x
|
Risk of Biasẟ
|
Results showed no overall reduction in mortality in 28 days. Patients over 60 years presented a lower mortality in a subgroup analysis.
|
18
|
Keller
|
73
|
Retrospective Observational
|
Unknown
|
1806
|
Early hospitalized patients
|
x
|
|
|
x
|
|
|
6
|
In high CRP group, glucocorticoids show significantly reduced risk of mortality or mechanical ventilation (odds ratio, 0.23; 95% CI, 0.08-0.70). In low CRP group glucocorticoids were associated with significantly increased risk of mortality or mechanical ventilation (OR, 2.64; 95% CI,1.39-5.03).
|
19
|
Li Hu
|
46
|
Retrospective Observational
|
Methylprednisolone high and low ED
|
203
|
Hospitalized patients
|
|
x
|
|
|
|
|
5
|
A dose response relation is suggested for corticosteroids on viral shedding. In addition, high-dose but not low-dose corticosteroids were found to potentially increase mortality in severe patients
|
20
|
Li Li
|
47
|
Retrospective Observational
|
Methylprednisolone or Prednisone < 1 mg/kg ED
|
475
|
Non Severe CoVID patients
|
x
|
x
|
x
|
|
|
x
|
5
|
Early, low-dose, and short-term corticosteroids therapy was associated with worse clinical outcomes
|
21
|
Li Zhou
|
48
|
Retrospective Observational
|
Methylprednisolone > 1 mg/kg ED
|
187
|
Radiologically progressive CoVID patients
|
|
|
|
x
|
x
|
|
6
|
Short-term, low-to-moderate-dose corticosteroids benefits patients with LDH levels of less than two times the ULN, who may be in the early phase of excessive inflammation
|
22
|
Lui Fang
|
49
|
Retrospective Observational
|
Methylprednisolone > 1 mg/kg ED
|
101
|
Hospitalized patients
|
x
|
|
|
|
|
|
3
|
The majority of patients present primarily with fever, and typical manifestations on chest imaging. Middle-aged and elderly patients with underlying comorbidities are susceptible to respiratory failure and may have a poorer prognosis.
|
23
|
Liu Zhang
|
81
|
Retrospective Observational
|
Unknown
|
1190
|
Hospitalized patients
|
x
|
|
|
|
|
|
5
|
Treatment with glucocorticoids increased the risk of progression from not severe to severe disease (OR 3.79, 95% CI 2.39–6.01)
|
24
|
Liu Zheng
|
50
|
Retrospective Observational
|
Methylprednisolone > 1 mg/kg ED
|
101
|
Hospitalized patients
|
|
x
|
|
|
x
|
|
5
|
Timely and appropriate application of methylprednisolone in
severe and critical patients may improve outcomes and lung function without negative impacts on specific SARS-CoV-2 IgG production
|
25
|
Lu Chen
|
51
|
Retrospective Observational
|
Methylprednisolone, Hydrocortisone or Dexamethasone > 1 mg/kg ED
|
244
|
Hospitalized patients
|
x
|
|
|
|
x
|
|
7
|
limited effect of corticosteroid therapy could pose to overall survival
of critically ill patients with COVID-19. Given the adverse effects, corticosteroid therapy must be commenced with caution, and prudent dosage should be promoted under certain circumstances.
|
26
|
Ma Qi
|
52
|
Retrospective Observational
|
Methylprednisolone 2 study- groups: High: > 1 mg/kg ED Low: < 1mg/kg ED
|
72
|
Severe and critical patients
|
x
|
x
|
x
|
x
|
|
|
6
|
Corticosteroids cannot reduce the hospital mortality, and is not associated with delayed viral clearance, but it could relieve the inflammatory storm and improve clinical symptoms in brief. Patients with severe COVID-19 could benefit from low-dose corticosteroids.
|
27
|
Ma Zeng
|
53
|
Retrospective Observational
|
Methylprednisolone > 1 mg/kg ED
|
450
|
Severe and non-severe patients
|
x
|
x
|
x
|
x
|
|
x
|
4
|
Corticosteroids use may be accompanied by increased use of antibiotics, longer hospitalization, and prolonged viral shedding.
|
28
|
Majmundar
|
54
|
Retrospective Observational
|
Prednisolone, Dexamethasone, Methylprednisolone > 1 mg/kg ED
|
205
|
Hospitalized patients
|
x
|
|
x
|
x
|
x
|
|
6
|
Corticosteroids were associated with a significantly lower risk of the ICU transfer, intubation, or in-hospital death,
|
29
|
Mikulska
|
55
|
Retrospective Observational
|
Methylprednisolone high and low ED
|
215
|
Hospitalized non- intubated patients
|
x
|
|
|
|
x
|
|
6
|
Early adjunctive treatment with tocilizumab, methylprednisolone or both may improve outcomes in non-intubated patients
|
30
|
Nelson
|
56
|
Retrospective Observational
|
Methylprednisolone > 1 mg/kg ED
|
117
|
ICU patients on Mechanical Ventilation
|
x
|
|
x
|
x
|
|
|
8
|
Methylprednisolone was associated with increased ventilator-free days and higher probability of extubation in a propensity-score matched cohort.
|
31
|
Rodriquez
|
57
|
Retrospective Observational
|
Methylprednisolone > 1 mg/kg ED
|
1014
|
Hospitalized patients
|
x
|
|
|
x
|
x
|
|
7
|
Tocilizumab should be prioritized for being tested in randomized trials targeting patients with data suggestive of a hyperinflammatory state The results for PDC were less consistent but are also encouraging.
|
32
|
Rubio
|
68
|
Retrospective Observational
|
Unknown
|
92
|
ICU and General ward patients
|
x
|
|
|
x
|
|
|
5
|
The early use of GC pulses could reduce the use tocilizumab and might decrease events such as intubation and death
|
33
|
Salton
|
58
|
Retrospective Observational
|
Methylprednisolone > 1 mg/kg ED
|
173
|
ARDS patients
|
x
|
|
x
|
x
|
|
|
8
|
Per-protocol administration of prolonged low-dose methylpred-nisolone treatment is associated with a significantly lower hazard of death, reduced ICU burden and decreased ventilator dependence.
|
34
|
Shen Zheng
|
59
|
Retrospective Observational
|
Methylprednisolone unknown dose
|
325
|
Hospitalized patients
|
|
x
|
|
|
|
|
4
|
COVID-19 cases in Shanghai were imported. Rapid identification, and effective control measures helped to contain the outbreak and prevent community transmission
|
35
|
Shi Wu
|
71
|
Retrospective Observational
|
Unknown
|
99
|
Hospitalized patients
|
|
x
|
|
|
|
|
4
|
SARS-CoV-2 RNA clearance time was associated with sex, disease severity, and lymphocyte function. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion.
|
36
|
Tomazini
|
37
|
Randomized controlled trial
|
Dexamethasone > 1 mg/kg ED
|
299
|
ICU patients with moderate to severe ARDS
|
x
|
|
|
x
|
|
x
|
Risk of Biasẟ
|
Dexamethasone plus standard care compared with standard care alone resulted in a significant increase in the number of ventilator-free days (days alive and free of mechanical ventilation) over 28 days
|
37
|
Wang Jiang
|
60
|
Retrospective Observational
|
Methylprednisolone
> 1 mg/kg ED
|
46
|
Severe hospitalized patients
|
x
|
|
|
x
|
x
|
|
7
|
early, low-dose and short-term application of methylprednisolone was associated with better clinical outcomes in severe CoVID-19 patients, and should be considered before onset of ARDS.
|
38
|
Wang Yang
|
67
|
Retrospective Observational
|
Unknown
|
69
|
Hospitalized patients
|
x
|
|
|
|
|
|
4
|
COVID-19 shows frequently fever, dry cough, and increase of inflammatory cytokines, and induced a mortality rate of 7.5%. Older patients or those with comorbidities are at higher risk of death.
|
38
|
Wang Zhang
|
69
|
Retrospective Observational
|
Unknown
|
548
|
Not Reported
|
x
|
|
|
|
|
|
6
|
Low-dose or no glucocorticoid treatment was associated with a lower hazard compared with high-dose treatment (≥ 1 mg/kg) for 15-day in hospital death
|
40
|
Wu Chen
|
61
|
Retrospective Observational
|
Methylprednisolone unknown dose
|
201
|
Hospitalized patients
|
x
|
|
|
|
|
|
4
|
Treatment with methylprednisolone may be beneficial for patients who develop ARDS.
|
41
|
Wu Huang
|
62
|
Retrospective Observational
|
Methylprednisolone < 1 mg/kg ED
|
1763
|
Severe or Critical patients
|
x
|
|
|
|
|
|
7
|
Corticosteroid use was not associated with beneficial effect in reducing in-hospital mortality for severe or critical cases in Wuhan.
|
42
|
Xu Chen
|
63
|
Retrospective Observational
|
Methylprednisolone < 1 mg/kg ED
|
113
|
Hospitalized patients
|
x
|
x
|
|
|
|
|
5
|
Prolonged SARS-CoV-2 RNA shedding was associated with male sex (P = .009), old age (P = .033), concomitant hypertension (P = .009),
delayed admission to hospital after illness onset (P = .001), severe illness at admission (P = .049), invasive mechanical ventilation
(P = .006), and corticosteroid treatment (P = .025).
|
43
|
Yang Lipes
|
64
|
Retrospective Observational
|
Methylprednisolone, Hydrocortisone or Dexamethasone > 1 mg/kg ED
|
15
|
ICU patients
|
x
|
|
|
|
x
|
|
6
|
Possible short-term clinical improvements with corticosteroid. Emphasis the urgent need for high-quality studies on Steroids and outcome in critically ill COVID- 19 patients.
|
44
|
Zha Li
|
65
|
Retrospective Observational
|
Methylprednisolone < 1 mg/kg ED
|
31
|
Hospitalized patients
|
x
|
x
|
x
|
|
|
|
5
|
No evidence of clinical benefit of corticosteroids was found for those without acute respiratory distress syndrome. Virus clearance may be slower in people with chronic HBV infections.
|