Efficacy and safety of corticosteroid regimens for the treatment of hospitalized COVID-19 patients: a meta-analysis

Abstract

Aim: To evaluate the efficacy and safety of corticosteroids for treating hospitalized COVID-19 patients.

Materials & methods: Efficacy outcomes included time to negative SARS-CoV-2 tests, length of stay, duration and incidence of intensive unit care stay, incidence of mortality and duration and incidence of mechanical ventilation. Safety outcomes included the incidence of adverse events and severe adverse events, incidence of hyperglycemia and incidence of nosocomial infections.

Results: Ninety-five randomized controlled trials (RCTs) and observational studies (n = 42,205) were included. Corticosteroids were associated with increased length of stay (based on RCT only), increased time to negative tests, decreased length of mechanical ventilation and increased odds of hyperglycemia.

Conclusion: Corticosteroids should be considered in patients requiring mechanical ventilation, and glycemic monitoring may be needed when administering corticosteroids.

Keywords: COVID-19; SARS-CoV-2; corticosteroids; length of stay; mechanical ventilation; mortality.

Figure 1.. PRISMA flowchart for the identification and selection of studies.

CNKI: China national knowledge infrastructure; CQVIP: Chongqing VIP information; EMBASE: Excerpta medica database; MEDLINE: Medical literature analysis and retrieval system online; PRISMA: Preferred reporting items for systematic reviews and Meta-Analyses.

Figure 2.. Risk of bias.

(A) Percentage of studies with risk of bias ratings for randomized controlled trials using RoB2. (B) Percentage of studies with risk of bias ratings for observational studies using ROBINS-I. ROBINS-I: Risk of bias in non-randomized studies of interventions; RoB2: Revised Cochrane risk of bias tool for randomized trial.

Figure 3.. Pooling of mean differences for the outcome of time to negative conversion of SARS-CoV-2 test.

The use of corticosteroids was compared with control groups. Heterogeneity was quantified using I² statistics. MD <0 indicates beneficial treatment effects of corticosteroids compared with control groups. MD: Mean difference; SD: Standard deviation.

Figure 4.. Pooling of mean differences for the outcome of length of stay.

The use of corticosteroids was compared with control groups. Heterogeneity was quantified using I² statistics. MD <0 indicates beneficial treatment effects of corticosteroids compared with control groups. IFN: Interferon; MD: Mean difference; SD: Standard deviation.

Figure 5.. Pooling of mean differences for intensive care unit length of stay and odds ratio for incidence of intensive care unit admission.

The use of corticosteroids was compared with control groups. Heterogeneity was quantified using I² statistics. (A) Forest plot for the pooling of MDs for ICU length of stay. MD <0 indicates beneficial treatment effects of corticosteroids compared with control groups. (B) Forest plot for the pooling of ORs for incidence of ICU admission. OR <1 indicates beneficial treatment effects of corticosteroids compared with control groups. MD: Mean difference; OR: Odds ratio; SD: Standard deviation; TCZ: Tocilizumab.

Figure 6.. Pooling of odds ratios for the outcome of mortality incidence.

The use of corticosteroids was compared with control groups. Heterogeneity was quantified using I² statistics. OR <1 indicates beneficial treatment effects of corticosteroids compared with control groups. IFN: Interferon; OR: Odds ratio; TCZ: Tocilizumab.

Figure 7.. Pooling of odds ratios for incidence of mechanical ventilation and mean differences for length of mechanical ventilation.

The use of corticosteroids was compared with control groups. Heterogeneity was quantified using I² statistics. (A) Forest plot for the pooling of ORs for incidence of mechanical ventilation. OR <1 indicates beneficial treatment effects of corticosteroids compared with control groups. (B) Forest plot for the pooling of MDs for length of mechanical ventilation. MD <0 indicates beneficial treatment effects of corticosteroids compared with control groups. MD: Mean difference; OR: Odds ratio; SD: Standard deviation; TCZ: Tocilizumab.

Figure 8.. Pooling of odds ratios for all safety outcomes.

The use of corticosteroids was compared with control groups. Heterogeneity was quantified using I² statistics. (A) Forest plot for the pooling of ORs for incidence of adverse events. (B) Forest plot for the pooling of ORs for incidence of serious adverse events. (C) Forest plot for the pooling of ORs for incidence of hyperglycemia. (D) Forest plot for the pooling of ORs for incidence of nosocomial infections. OR <1 indicates beneficial treatment effects of corticosteroids compared with control groups for all safety outcomes. OR: Odds ratio; TCZ: Tocilizumab.