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Efficacy and safety of systematic corticosteroids among severe COVID-19 patients:a systematic review and meta-analysis of randomized controlled trials

查看全文 作　　者：Shaolei [1]Ma;Changsheng [1]Xu;Shijiang [2]Liu;Xiaodi [3]Sun;Renqi [4]Li;Mingjie [4]Mao;Shanwu [5]Feng;Xian [5]Wang 高影响力作者 机构地区：[1]Department of Emergency and Critical Care Medicine,Zhongda Hospital Affiliated to Southeast University,Nanjing,China;[2]Department of Anesthesiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,China;[3]Department of Pain Medicine,The First Affiliated Hospital of Nanjing Medical University,Nanjing,China;[4]Department of Anesthesiology,Jinling Hospital,School of Medicine,Nanjing University,Nanjing,China;[5]Department of Anesthesiology,Women's Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing,China高影响力机构 出　　处：《Signal Transduction and Targeted Therapy》索引2021年第6卷第3期,共7页高影响力期刊 基　　金：supported by grants from the National Natural Science Foundation of China(81600960 and 81971045). 摘　　要：The benefits and harms of corticosteroids for patients with severe coronavirus disease 2019(COVID-19)remain unclear.We systematically searched PubMed,Embase,and Cochrane Central Register of Controlled Trials from December 31,2019 to October 1,2020 to identify randomized controlled trials(RCTs)that evaluated corticosteroids in severe COVID-19 patients.The primary outcome was all-cause mortality at the longest follow-up.Secondary outcomes included a composite disease progression(progression to intubation,ventilation,extracorporeal membrane oxygenation,ICU transfer,or death among those not ventilated at enrollment)and incidence of serious adverse events.A random-effects model was applied to calculate risk ratio(RR)with 95%confidence intervals(Cis).We used the Grading of Recommendations Assessment,Development,and Evaluation approach to evaluate the certainty of the evidence.Seven RCTs involving 6250 patients were included,of which the Randomized Evaluation of COVID-19 Therapy(RECOVERY)trial comprised nearly 78%of all included subjects.Results showed that corticosteroids were associated with a decreased all-cause mortality(27.3 vs.31.1%;RR:0.85;95%CI:0.73-0.99;P=0.04;low-certainty evidence).Trial sequential analysis suggested that more trials were still required to confirm the results.However,such survival benefit was absent if RECOVERY trial was excluded(RR:0.83;95%CI:0.65-1.06;P=0.13).Furthermore,corticosteroids decreased the occurrence of composite disease progression(30.6 vs.33.3%;RR:0.77;95%CI:0.64-0.92;P=0.005),but not increased the incidence of serious'adverse events(3.5 vs.3.4%;RR:1.16;95%CI:0.39-3.43;P=0.79). 关 键 词：PATIENTS COR STEROIDS
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