Systemic Corticosteroid Administration in Coronavirus Disease 2019 Outcomes: An Umbrella Meta-Analysis Incorporating Both Mild and Pulmonary Fibrosis-Manifested Severe Disease.

Bin Cheng,Binghao Zhao,Jinxiu Ma,Tingting Shao,Linxiang Zeng,Yani Yang

doi:10.3389/fphar.2021.670170

Abstract

Background: Effective treatments for coronavirus disease 2019 (COVID-19) are urgently needed. The real role of corticosteroid use in COVID-19 has long been of interest and is disputable. Methods: We aimed to quantitatively reevaluate the efficacy of corticosteroids on COVID-19. Databases were searched for eligible meta-analyses/systematic reviews with available outcome data. For each association, we estimated the summary effect size with fixed- and random-effects models, 95% confidence intervals, and 95% prediction intervals. Heterogeneity, Egger’s test, evidence of small-study effects and excess significance bias, and subgroup analyses were rigorously evaluated. Results: Intended outcomes of 12 eligible studies were mortality, clinical improvement, hospitalization, mechanical ventilation (MV), adverse events (AEs), intensive care unit (ICU) stay, hospital stay, virus clearance time (VCT), and negative conversion. Corticosteroid administration was associated with a 27% risk reduction in MV [hazard ratio (HR): 0.73 (0.64–0.83)] and a 20% reduction in mortality of critically ill/severe COVID-19 patients [HR: 0.80 (0.65–0.98)]. Interestingly, shorter ICU stays and, conversely, potentially longer hospital stays, a longer VCT, and a longer time to negative conversion were associated with corticosteroid use. There was no significant impact of different corticosteroid doses on mortality. Only one study showed slightly excess significant bias. Caution should be applied given the weak nature of the evidence, and it has been confirmed by sensitivity analyses too. Conclusion: This umbrella study found benefits from corticosteroids on MV and especially the mortality of critically ill/severe patients with shorter ICU stays but prolonged hospital stays and VCT. The benefits and harms should be reevaluated and balanced before corticosteroids are cautiously prescribed in clinical practice.

Highlights

At the end of 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV-2), broke out in Wuhan, China (Zhou et al, 2020); by March 11, 2020, the outbreak was declared a pandemic of coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) (Zhang et al, 2020)
Corticosteroid use was significantly associated with a decreased intensive care unit (ICU) stay time; it seemed to lead to a prolonged hospital stay and a longer virus clearance time (VCT) and negative conversion time
The current umbrella synthesis indicates that corticosteroid use is associated with reduced mechanical ventilation (MV) and mortality in critically ill/severe COVID-19 patients, and corticosteroid use leads to a decreased ICU stay but possibly a prolonged hospital stay, a longer VCT, and a longer time to negative conversion

Summary

Introduction

At the end of 2019, a novel coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV-2), broke out in Wuhan, China (Zhou et al, 2020); by March 11, 2020, the outbreak was declared a pandemic of coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) (Zhang et al, 2020). The results of the meta-analysis were controversial since a previous meta-analysis demonstrated that COVID-19 patients who used corticosteroids were more likely to develop critical illness and had a higher mortality and longer hospital stays (Wang et al, 2020) Another meta-analysis showed a significant reduction in short-term mortality [odds ratio (OR): 0.72, 95% CI: 0.57–0.87] and the need to receive mechanical ventilation (MV) compared to SOC, the data were sparse to draw firm conclusions (van Paassen et al, 2020). The real role of corticosteroid use in COVID-19 has long been of interest and is disputable

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