Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis
We performed a meta-analysis to determine safety and efficacy of corticosteroids in SARS-CoV-2, SARS-CoV, and MERS-CoV infections. We searched PubMed, Web of Science, Medline, WanFang Chinese database, and ZhiWang Chinese database using Boolean operators and search terms covering SARS-CoV-2, SARS-Co...
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| Veröffentlicht in: | Leukemia 2020-06, Vol.34 (6), p.1503-1511 |
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| creator | Li, Huan Chen, Chongxiang Hu, Fang Wang, Jiaojiao Zhao, Qingyu Gale, Robert Peter Liang, Yang |
| description | We performed a meta-analysis to determine safety and efficacy of corticosteroids in SARS-CoV-2, SARS-CoV, and MERS-CoV infections. We searched PubMed, Web of Science, Medline, WanFang Chinese database, and ZhiWang Chinese database using Boolean operators and search terms covering SARS-CoV-2, SARS-CoV, OR MERS-CoV AND corticosteroids to find appropriate studies. Review Manager 5.3 was used to analyze results of meta-analysis. Observational studies were analyzed for quality using the modified Newcastle–Ottawa scale and randomized clinical trials, using the Jadad scale. Subjects were divided into those with severe-only and other (severe and not severe) cohorts based on published criteria. Efficacy endpoints studied included mortality, hospitalization duration, rates of intensive care unit (ICU) admission, use of mechanical ventilation, and a composite endpoint (death, ICU admission, or mechanical ventilation). We included 11 reports including 10 cohort studies and 1 randomized clinical trial involving 5249 subjects (2003–2020). Two discussed the association of corticosteroids and virus clearing and 10 explored how corticosteroids impacted mortality, hospitalization duration, use of mechanical ventilation, and a composite endpoint. Corticosteroid use was associated with delayed virus clearing with a mean difference (MD) = 3.78 days (95% confidence Interval [CI] = 1.16, 6.41 days;
I
2
= 0%). There was no significant reduction in deaths with relative Risk Ratio (RR) = 1.07 (90% CI = 0.81; 1.42;
I
2
= 80%). Hospitalization duration was prolonged and use of mechanical ventilation increased. In conclusion, corticosteroid use in subjects with SARS-CoV-2, SARS-CoV, and MERS-CoV infections delayed virus clearing and did not convincingly improve survival, reduce hospitalization duration or ICU admission rate and/or use of mechanical ventilation. There were several adverse effects. Because of a preponderance of observational studies in the dataset and selection and publication biases our conclusions, especially regarding SARS-CoV-2, need confirmation in a randomized clinical trial. In the interim we suggest caution using corticosteroids in persons with COVID-19. |
| doi_str_mv | 10.1038/s41375-020-0848-3 |
| format | Article |
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I
2
= 0%). There was no significant reduction in deaths with relative Risk Ratio (RR) = 1.07 (90% CI = 0.81; 1.42;
I
2
= 80%). Hospitalization duration was prolonged and use of mechanical ventilation increased. In conclusion, corticosteroid use in subjects with SARS-CoV-2, SARS-CoV, and MERS-CoV infections delayed virus clearing and did not convincingly improve survival, reduce hospitalization duration or ICU admission rate and/or use of mechanical ventilation. There were several adverse effects. Because of a preponderance of observational studies in the dataset and selection and publication biases our conclusions, especially regarding SARS-CoV-2, need confirmation in a randomized clinical trial. In the interim we suggest caution using corticosteroids in persons with COVID-19.</description><identifier>ISSN: 0887-6924</identifier><identifier>EISSN: 1476-5551</identifier><identifier>DOI: 10.1038/s41375-020-0848-3</identifier><identifier>PMID: 32372026</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/699/255 ; 692/700/565/1436 ; Adrenal Cortex Hormones - therapeutic use ; Analysis ; Betacoronavirus - drug effects ; Boolean algebra ; Cancer Research ; China ; Clearing ; Clinical trials ; Confidence intervals ; Coronavirus Infections - drug therapy ; Coronavirus Infections - virology ; Corticoids ; Corticosteroids ; COVID-19 ; Critical Care Medicine ; Health aspects ; Hematology ; Hospitalization ; Humans ; Infections ; Intensive ; Internal Medicine ; Mechanical ventilation ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Meta-analysis ; Middle East respiratory syndrome ; Middle East Respiratory Syndrome Coronavirus - drug effects ; Mortality ; Oncology ; Pandemics ; Pneumonia, Viral - drug therapy ; Pneumonia, Viral - virology ; Review ; Review Article ; SARS Virus - drug effects ; SARS-CoV-2 ; Severe acute respiratory syndrome ; Severe Acute Respiratory Syndrome - drug therapy ; Severe Acute Respiratory Syndrome - virology ; Severe acute respiratory syndrome coronavirus 2 ; United Kingdom ; Ventilation ; Ventilators ; Viral diseases ; Viruses</subject><ispartof>Leukemia, 2020-06, Vol.34 (6), p.1503-1511</ispartof><rights>The Author(s), under exclusive licence to Springer Nature Limited 2020</rights><rights>COPYRIGHT 2020 Nature Publishing Group</rights><rights>The Author(s), under exclusive licence to Springer Nature Limited 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c596t-5bacdb658f50984506d028bc03969dcbba5fd358adb3767432d80e4c6cc8ae303</citedby><cites>FETCH-LOGICAL-c596t-5bacdb658f50984506d028bc03969dcbba5fd358adb3767432d80e4c6cc8ae303</cites><orcidid>0000-0002-4226-9580</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32372026$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Huan</creatorcontrib><creatorcontrib>Chen, Chongxiang</creatorcontrib><creatorcontrib>Hu, Fang</creatorcontrib><creatorcontrib>Wang, Jiaojiao</creatorcontrib><creatorcontrib>Zhao, Qingyu</creatorcontrib><creatorcontrib>Gale, Robert Peter</creatorcontrib><creatorcontrib>Liang, Yang</creatorcontrib><title>Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis</title><title>Leukemia</title><addtitle>Leukemia</addtitle><addtitle>Leukemia</addtitle><description>We performed a meta-analysis to determine safety and efficacy of corticosteroids in SARS-CoV-2, SARS-CoV, and MERS-CoV infections. We searched PubMed, Web of Science, Medline, WanFang Chinese database, and ZhiWang Chinese database using Boolean operators and search terms covering SARS-CoV-2, SARS-CoV, OR MERS-CoV AND corticosteroids to find appropriate studies. Review Manager 5.3 was used to analyze results of meta-analysis. Observational studies were analyzed for quality using the modified Newcastle–Ottawa scale and randomized clinical trials, using the Jadad scale. Subjects were divided into those with severe-only and other (severe and not severe) cohorts based on published criteria. Efficacy endpoints studied included mortality, hospitalization duration, rates of intensive care unit (ICU) admission, use of mechanical ventilation, and a composite endpoint (death, ICU admission, or mechanical ventilation). We included 11 reports including 10 cohort studies and 1 randomized clinical trial involving 5249 subjects (2003–2020). Two discussed the association of corticosteroids and virus clearing and 10 explored how corticosteroids impacted mortality, hospitalization duration, use of mechanical ventilation, and a composite endpoint. Corticosteroid use was associated with delayed virus clearing with a mean difference (MD) = 3.78 days (95% confidence Interval [CI] = 1.16, 6.41 days;
I
2
= 0%). There was no significant reduction in deaths with relative Risk Ratio (RR) = 1.07 (90% CI = 0.81; 1.42;
I
2
= 80%). Hospitalization duration was prolonged and use of mechanical ventilation increased. In conclusion, corticosteroid use in subjects with SARS-CoV-2, SARS-CoV, and MERS-CoV infections delayed virus clearing and did not convincingly improve survival, reduce hospitalization duration or ICU admission rate and/or use of mechanical ventilation. There were several adverse effects. Because of a preponderance of observational studies in the dataset and selection and publication biases our conclusions, especially regarding SARS-CoV-2, need confirmation in a randomized clinical trial. In the interim we suggest caution using corticosteroids in persons with COVID-19.</description><subject>692/699/255</subject><subject>692/700/565/1436</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Analysis</subject><subject>Betacoronavirus - drug effects</subject><subject>Boolean algebra</subject><subject>Cancer Research</subject><subject>China</subject><subject>Clearing</subject><subject>Clinical trials</subject><subject>Confidence intervals</subject><subject>Coronavirus Infections - drug therapy</subject><subject>Coronavirus Infections - virology</subject><subject>Corticoids</subject><subject>Corticosteroids</subject><subject>COVID-19</subject><subject>Critical Care Medicine</subject><subject>Health aspects</subject><subject>Hematology</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Infections</subject><subject>Intensive</subject><subject>Internal Medicine</subject><subject>Mechanical ventilation</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Meta-analysis</subject><subject>Middle East respiratory syndrome</subject><subject>Middle East Respiratory Syndrome Coronavirus - 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therapeutic use</topic><topic>Analysis</topic><topic>Betacoronavirus - drug effects</topic><topic>Boolean algebra</topic><topic>Cancer Research</topic><topic>China</topic><topic>Clearing</topic><topic>Clinical trials</topic><topic>Confidence intervals</topic><topic>Coronavirus Infections - drug therapy</topic><topic>Coronavirus Infections - virology</topic><topic>Corticoids</topic><topic>Corticosteroids</topic><topic>COVID-19</topic><topic>Critical Care Medicine</topic><topic>Health aspects</topic><topic>Hematology</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Infections</topic><topic>Intensive</topic><topic>Internal Medicine</topic><topic>Mechanical ventilation</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Meta-analysis</topic><topic>Middle East respiratory syndrome</topic><topic>Middle East Respiratory Syndrome Coronavirus - drug effects</topic><topic>Mortality</topic><topic>Oncology</topic><topic>Pandemics</topic><topic>Pneumonia, Viral - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Leukemia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Huan</au><au>Chen, Chongxiang</au><au>Hu, Fang</au><au>Wang, Jiaojiao</au><au>Zhao, Qingyu</au><au>Gale, Robert Peter</au><au>Liang, Yang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis</atitle><jtitle>Leukemia</jtitle><stitle>Leukemia</stitle><addtitle>Leukemia</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>34</volume><issue>6</issue><spage>1503</spage><epage>1511</epage><pages>1503-1511</pages><issn>0887-6924</issn><eissn>1476-5551</eissn><abstract>We performed a meta-analysis to determine safety and efficacy of corticosteroids in SARS-CoV-2, SARS-CoV, and MERS-CoV infections. We searched PubMed, Web of Science, Medline, WanFang Chinese database, and ZhiWang Chinese database using Boolean operators and search terms covering SARS-CoV-2, SARS-CoV, OR MERS-CoV AND corticosteroids to find appropriate studies. Review Manager 5.3 was used to analyze results of meta-analysis. Observational studies were analyzed for quality using the modified Newcastle–Ottawa scale and randomized clinical trials, using the Jadad scale. Subjects were divided into those with severe-only and other (severe and not severe) cohorts based on published criteria. Efficacy endpoints studied included mortality, hospitalization duration, rates of intensive care unit (ICU) admission, use of mechanical ventilation, and a composite endpoint (death, ICU admission, or mechanical ventilation). We included 11 reports including 10 cohort studies and 1 randomized clinical trial involving 5249 subjects (2003–2020). Two discussed the association of corticosteroids and virus clearing and 10 explored how corticosteroids impacted mortality, hospitalization duration, use of mechanical ventilation, and a composite endpoint. Corticosteroid use was associated with delayed virus clearing with a mean difference (MD) = 3.78 days (95% confidence Interval [CI] = 1.16, 6.41 days;
I
2
= 0%). There was no significant reduction in deaths with relative Risk Ratio (RR) = 1.07 (90% CI = 0.81; 1.42;
I
2
= 80%). Hospitalization duration was prolonged and use of mechanical ventilation increased. In conclusion, corticosteroid use in subjects with SARS-CoV-2, SARS-CoV, and MERS-CoV infections delayed virus clearing and did not convincingly improve survival, reduce hospitalization duration or ICU admission rate and/or use of mechanical ventilation. There were several adverse effects. Because of a preponderance of observational studies in the dataset and selection and publication biases our conclusions, especially regarding SARS-CoV-2, need confirmation in a randomized clinical trial. In the interim we suggest caution using corticosteroids in persons with COVID-19.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>32372026</pmid><doi>10.1038/s41375-020-0848-3</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4226-9580</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0887-6924 |
| ispartof | Leukemia, 2020-06, Vol.34 (6), p.1503-1511 |
| issn | 0887-6924 1476-5551 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7199650 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | 692/699/255 692/700/565/1436 Adrenal Cortex Hormones - therapeutic use Analysis Betacoronavirus - drug effects Boolean algebra Cancer Research China Clearing Clinical trials Confidence intervals Coronavirus Infections - drug therapy Coronavirus Infections - virology Corticoids Corticosteroids COVID-19 Critical Care Medicine Health aspects Hematology Hospitalization Humans Infections Intensive Internal Medicine Mechanical ventilation Medical research Medicine Medicine & Public Health Medicine, Experimental Meta-analysis Middle East respiratory syndrome Middle East Respiratory Syndrome Coronavirus - drug effects Mortality Oncology Pandemics Pneumonia, Viral - drug therapy Pneumonia, Viral - virology Review Review Article SARS Virus - drug effects SARS-CoV-2 Severe acute respiratory syndrome Severe Acute Respiratory Syndrome - drug therapy Severe Acute Respiratory Syndrome - virology Severe acute respiratory syndrome coronavirus 2 United Kingdom Ventilation Ventilators Viral diseases Viruses |
| title | Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T06%3A10%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20corticosteroid%20therapy%20on%20outcomes%20of%20persons%20with%20SARS-CoV-2,%20SARS-CoV,%20or%20MERS-CoV%20infection:%20a%20systematic%20review%20and%20meta-analysis&rft.jtitle=Leukemia&rft.au=Li,%20Huan&rft.date=2020-06-01&rft.volume=34&rft.issue=6&rft.spage=1503&rft.epage=1511&rft.pages=1503-1511&rft.issn=0887-6924&rft.eissn=1476-5551&rft_id=info:doi/10.1038/s41375-020-0848-3&rft_dat=%3Cgale_pubme%3EA625609954%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2408813792&rft_id=info:pmid/32372026&rft_galeid=A625609954&rfr_iscdi=true |