Abstract
BackgroundEvidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear.MethodsIn this systematic review and meta-analysis, we searched for studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, and ClinicalTrials.gov from 2019 to April 20, 2021. We mainly pooled the risk ratios (RRs) and mean difference (MD) for viral clearance delay and did subgroup analyses by the severity of illness and doses of glucocorticoids.Results38 studies with a total of 9572 patients were identified. Glucocorticoids treatment was associated with delayed viral clearance in COVID-19 patients (adjusted RR 1.52, 95% CI 1.29 to 1.80, I2 = 52%), based on moderate-quality evidence. In subgroup analyses, risk of viral clearance delay was significant both for COVID-19 patients being mild or moderate ill (adjusted RR 1.86, 95% CI 1.35 to 2.57, I2 = 48%), and for patients of being severe or critical ill (adjusted RR 1.59, 95% CI 1.23 to 2.07, I2 = 0%); however, this risk significantly increased for patients taking high doses (unadjusted RR 1.85, 95% CI 1.08 to 3.18; MD 7.19, 95% CI 2.78 to 11.61) or medium doses (adjusted RR 1.86, 95% CI 0.96 to 3.62, I2 = 45%; MD 3.98, 95% CI 3.07 to 4.88, I2 = 4%), rather those taking low doses (adjusted RR 1.38, 95% CI 0.94 to 2.02, I2 = 59%; MD 1.46, 95% CI −0.79 to 3.70, I2 = 82%).ConclusionsGlucocorticoids treatment delayed viral clearance in COVID-19 patients of taking high doses or medium doses, rather in those of taking low doses of glucocorticoids.
Highlights
As of early August 2021, nearly 200 million people have been confirmed with COVID-19, and more than 4 million died according to WHO official updates of global data on COVID-19 [1]
Guidance and protocol We reported our study according to standards of the meta-analysis of observational studies in epidemiology (MOOSE) [4] and preferred reporting items for systematic reviews and meta-analyses (PRISMA) [5]
Eligibility criteria and definitions We considered criteria of eligible studies as follows: participants were COVID-19 patients infected with SARSCoV-2 confirmed through the nucleic acid test; the intervention was glucocorticoids, no matter types, and doses; the controls were COVID-19 patients receiving usual care except glucocorticoids treatment; the outcomes should involve viral clearance, no matter what kind of data was presented
Summary
As of early August 2021, nearly 200 million people have been confirmed with COVID-19, and more than 4 million died according to WHO official updates of global data on COVID-19 [1]. Li et al BMC Infect Dis (2021) 21:1063 glucocorticoids treatment and decreased mortality in COVID-19 patients of critical illness. These results are encouraging, glucocorticoids theoretically delay virus removal. No study has systematically assessed glucocorticoids treatment effects on viral clearance for COVID-19. We conducted this systematic review and meta-analysis to evaluate this potential effect from glucocorticoids treatment for COVID-19. Of four authors (H.Y. and W.Z.; Y.Z. and LP.W.). Further screening was conducted to determine whether the item met the rest eligibility criteria. Disagreements were resolved by consensus, and if necessary, consultation with a third author (ZW.Z.). Evidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear
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