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Meta-Analysis
. 2020 Jul;81(1):e13-e20.
doi: 10.1016/j.jinf.2020.03.062. Epub 2020 Apr 10.

The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis

Zhenwei Yang  1 , Jialong Liu  1 , Yunjiao Zhou  1 , Xixian Zhao  1 , Qiu Zhao  1 , Jing Liu  2
Affiliations
Meta-Analysis

The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis

Zhenwei Yang et al. J Infect. 2020 Jul.

Abstract

Objectives: An outbreak of novel coronavirus in 2019 threatens the health of people, and there is no proven pharmacological treatment. Although corticosteroids were widely used during outbreaks of severe acute respiratory syndrome and Middle East respiratory syndrome, their efficacy remainedhighly controversial. We aimed to further evaluate the influence of corticosteroids on patients with coronavirus infection.

Methods: We conducted a comprehensive search of literature published in PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure (CNKI) from January 1, 2002 to March 15, 2020. All statistical analyses in this study were performed on stata14.0.

Results: A total of 5270 patients from 15 studies were included in this meta-analysis. The result indicated that critical patients were more likely to require corticosteroids therapy (risk ratio [RR] = 1.56, 95% confidence interval [CI] = 1.28-1.90, P<0.001). However, corticosteroid treatment was associated with higher mortality (RR = 2.11, 95%CI = 1.13-3.94, P = 0.019), longer length of stay (weighted mean difference [WMD] = 6.31, 95%CI = 5.26-7.37, P<0.001), a higher rate of bacterial infection (RR = 2.08, 95%CI = 1.54-2.81, P<0.001), and hypokalemia (RR = 2.21, 95%CI = 1.07-4.55, P = 0.032) but not hyperglycemia (RR = 1.37, 95%CI=0.68-2.76, P = 0.376) or hypocalcemia (RR = 1.35, 95%CI = 0.77-2.37, P = 0.302).

Conclusions: Patients with severe conditions are more likely to require corticosteroids. Corticosteroid use is associated with increased mortality in patients with coronavirus pneumonia.

Keywords: COVID-19; Coronavirus; Meta-analysis; corticosteroid treatment.

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Conflict of interest statement

Declaration of Competing Interest No authors have competing interests in this research.

Figures

Fig 1
Fig. 1
Flow chart of literature search and selection of studies.
Fig 2
Fig. 2
The use of corticosteroids in critical and non-critical patients.
Fig 3
Fig. 3
Effect of corticosteroids on mortality.
Fig 4
Fig. 4
Effect of corticosteroids on length of stay (LOS).
Fig 5
Fig. 5
(A) Funnel plot of the use of corticosteroids in critical and non-critical patients. (B) Funnel plot of mortality.
See this image and copyright information in PMC

Comment in

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