From: Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes
Outcomes | Total no events/total no of patients | Relative effect (95% CI) | No of participants (studies) | Certainty of evidence (Grade a) | Comments | |
---|---|---|---|---|---|---|
Standard care | Corticosteroids | |||||
Effect of corticosteroids in hospitalized CoVID-19 patients. Intervention: Corticosteroids; Comparison: Standard of Care | ||||||
In-hospital mortality | 1547/9080 (17.0%) | 1173/5234 (22.4%) | Estimate 0.72 (0.57–0.87) | 14.187b (22) | RCT: moderate Non RCT: Very low | Corticosteroids reduce mortality in CoVID-19 hospitalized patients |
Requirement of mechanical ventilation | 124/467 (26,6%) | 89/472 (18,9%) | Estimate 0.70 (0.54–0.91) | 939 (7) | All studies: Very low | 17 studies reported on mechanical ventilation, but effects could only be quantified in 7 studies |
Descriptive results: Data too heterogeneous for quantification of effect | ||||||
Viral Clearance | In corticosteroid group viral clearance time ranged from 10 to 29 days in corticosteroids group and from 8 to 24 days in standard of care group | 2.556 (13) | 0 × RCT 13 × retrospective observational study | Heterogeneous outcome reporting. Corticosteroids are associated with a probable delay in viral clearance | ||
Length of hospital stay | Conflicting results both in favor and against the use of corticosteroids | 9.433 (12) | 2 × RCT, 10 × retrospective observational study | Effect of corticosteroids on length of hospital stay is uncertain | ||
Mechanical ventilation | In 14 out of 17 studies, corticosteroids therapy is associated with beneficial effects on ventilator-free days, on respiratory failure requiring mechanical ventilation and time on mechanical ventilator | 12.114 (17) | 5 × RCT, 12 × retrospective observational study | Beneficial effects of corticosteroids on mechanical ventilation different definitions used) | ||
Oxygenation | Outcome reporting in saturation, p/F ratio and oxygen demand. Conflicting results in favor and against the use of corticosteroids | 3.211 (11) | 1 × RCT, 10 × retrospective observational study | Outcome definition too heterogeneous to draw conclusions | ||
Secondary infections | In five out of six studies, secondary infections and antibiotic use are increased | 2.145 (6) | 3 × RCT 3 × retrospective observational study | Corticosteroids are associated with an increase in infectious complications |