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Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes: Systematic Review and Meta-analysis

Chest, 2021-03, Vol.159 (3), p.1019-1040 [Peer Reviewed Journal]

Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. ;2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. 2020 American College of Chest Physicians ;ISSN: 0012-3692 ;EISSN: 1931-3543 ;DOI: 10.1016/j.chest.2020.10.054 ;PMID: 33129791

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  • Title:
    Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes: Systematic Review and Meta-analysis
  • Author: Cano, Edison J ; Fonseca Fuentes, Xavier ; Corsini Campioli, Cristina ; O'Horo, John C ; Abu Saleh, Omar ; Odeyemi, Yewande ; Yadav, Hemang ; Temesgen, Zelalem
  • Subjects: COVID-19 - drug therapy ; COVID-19 - epidemiology ; Critical Care: Original Research ; Dose-Response Relationship, Drug ; Glucocorticoids - pharmacology ; Humans ; Mortality ; SARS-CoV-2 - drug effects ; SARS-CoV-2 - physiology ; Virus Shedding - drug effects
  • Is Part Of: Chest, 2021-03, Vol.159 (3), p.1019-1040
  • Description: Since its appearance in late 2019, infections caused by severe acute respiratory syndrome coronavirus 2 have created unprecedented challenges for health systems worldwide. Multiple therapeutic options have been explored, including corticosteroids. Preliminary results of corticosteroids in coronavirus disease 2019 (COVID-19) are encouraging; however, the role of corticosteroids remains controversial. What is the impact of corticosteroids in mortality, ICU admission, mechanical ventilation, and viral shedding in COVID-19 patients? We conducted a systematic review of literature on corticosteroids and COVID-19 in major databases (PubMed, MEDLINE, and EMBASE) of published literature through July 22, 2020, that report outcomes of interest in COVID-19 patients receiving corticosteroids with a comparative group. A total of 73 studies with 21,350 COVID-19 patients were identified. Corticosteroid use was reported widely in mechanically ventilated patients (35.3%), ICU patients (51.3%), and severe COVID-19 patients (40%). Corticosteroids showed mortality benefit in severelly ill COVID-19 patients (OR, 0.65; 95% CI, 0.51-0.83; P = .0006); however, no beneficial or harmful effects were noted among high-dose or low-dose corticosteroid regimens. Emerging evidence shows that low-dose corticosteroids do not have a significant impact in the duration of SARS-CoV-2 viral shedding. The analysis was limited by highly heterogeneous literature for high-dose and low-dose corticosteroids regimens. Our results showed evidence of mortality benefit in severely ill COVID-19 patients treated with corticosteroids. Corticosteroids are used widely in COVID-19 patients worldwide, and a rapidly developing global pandemic warrants further high-quality clinical trials to define the most beneficial timing and dosing for corticosteroids.
  • Publisher: United States: American College of Chest Physicians. Published by Elsevier Inc
  • Language: English
  • Identifier: ISSN: 0012-3692
    EISSN: 1931-3543
    DOI: 10.1016/j.chest.2020.10.054
    PMID: 33129791
  • Source: MEDLINE
    Alma/SFX Local Collection
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