High-dose versus low-dose corticosteroids in COVID-19 patients: A systematic review and meta-analysis

Tan, Rachel Si Jing and Ng, Ka Ting and Xin, Chua Ee and Atan, Rafidah and Yunos, Norazim Mohd and Hasan, Mohd Shahnaz (2022) High-dose versus low-dose corticosteroids in COVID-19 patients: A systematic review and meta-analysis. Journal of Cardiothoracic and Vascular Anesthesia, 36 (9). pp. 3576-3586. ISSN 1053-0770, DOI https://doi.org/10.1053/j.jvca.2022.05.011.

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The clinical efficacy of corticosteroids remains unclear. The primary aim of this systematic review and meta-analysis was to evaluate the use of high-dose versus low-dose corticosteroids on the mortality rate of COVID-19 patients. Design: Systematic review and meta-analysis. Setting: Electronic search for randomized controlled trials and observational studies (MEDLINE, EMBASE, CENTRAL). Participants: Hospitalized adults >= 18 years old who were SARS-CoV-2 PCR positive. Interventions: High-dose and low-dose corticosteroids. Measurements and Main Results: A total of twelve studies (n=2759 patients) were included in this review. The pooled analysis demonstrated no significant difference in mortality rate between the high-dose and low-dose corticosteroids groups (n=2632; OR: 1.07 95%CI 0.67, 1.72], p=0.77, I-2 =76%, trial sequential analysis=inconclusive). No significant differences were observed in the incidence of intensive care unit (ICU) admission rate (n=1544; OR: 0.7795%CI 0.43, 1.37], p=0.37, I-2 = 72%), duration of hospital stay (n=1615; MD: 0.5395%CI -1.36, 2.41], p=0.58, I-2=87%), respiratory support (n=1694; OR: 1.5195%CI 0.77, 2.96], p=0.23, I-2=84%), duration of mechanical ventilation (n=419; MD: -1.4495%CI -4.27, 1.40], p=0.32, I-2=93%), incidence of hyperglycemia (n=516, OR: 0.9195%CI 0.58, 1.43], p=0.68, I-2=0%) and infection rate (n=1485, OR: 0.8695%CI 0.64, 1.16], p=0.33, I-2=29%). Conclusion: The meta-analysis demonstrated high-dose corticosteroids did not reduce mortality rate. However, high-dose corticosteroids did not pose higher risk of hyperglycemia and infection rate for COVID-19 patients. Due to the inconclusive trial sequential analysis, substantial heterogeneity and low level of evidence, future large-scale randomized clinical trials are warranted to improve the certainty of evidence for the use of high-dose compared to low-dose corticosteroids in COVID-19 patients. (C) 2022 Elsevier Inc. All rights reserved.

Item Type: Article
Uncontrolled Keywords: Coronavirus; COVID-19; SARS-CoV-2; Corticosteroids; Methylprednisolone; Dexamethasone
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 14 Sep 2023 03:18
Last Modified: 14 Sep 2023 03:18
URI: http://eprints.um.edu.my/id/eprint/41216

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