Evidence map›Paper›PMID 33317589›Full record

SynthesisCritical care (London, England)2020

Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes.

Judith van Paassen, Jeroen S Vos, Eva M Hoekstra, Katinka M I Neumann, Pauline C Boot, Sesmu M Arbous

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 229 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
229citing papers in PubMed, 18 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

229 citing papers in PubMed, 18 syntheses or guidelines pooled it.

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  10. Steroid therapy and antiviral treatment in SARS-CoV-2 pneumonia: clinical contexts and indications.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2022
    Pooled it
  11. Inhaled corticosteroids for the treatment of COVID-19.The Cochrane database of systematic reviews · 2022
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  15. Use of steroids in COVID-19 patients: A meta-analysis.European journal of pharmacology · 2022
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  18. Systemic corticosteroids for the treatment of COVID-19.The Cochrane database of systematic reviews · 2021
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  20. Comparison of the effect of intravenous dexamethasone and methylprednisolone on the treatment of hospitalized patients with COVID-19: a randomized clinical trial.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2022
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169 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Judith van PaassenDepartment of Intensive Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Jeroen S VosDepartment of Intensive Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Eva M HoekstraFaculty of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Katinka M I NeumannFaculty of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Pauline C BootFaculty of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Sesmu M ArbousDepartment of Intensive Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. [email protected].ORCID 0000-0001-5242-3257

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn the current SARS-CoV-2 pandemic, there has been worldwide debate on the use of corticosteroids in COVID-19. In the recent RECOVERY trial, evaluating the effect of dexamethasone, a reduced 28-day mortality in patients requiring oxygen therapy or mechanical ventilation was shown. Their results have led to considering amendments in guidelines or actually already recommending corticosteroids in COVID-19. However, the effectiveness and safety of corticosteroids still remain uncertain, and reliable data to further shed light on the benefit and harm are needed.

objectivesThe aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of corticosteroids in COVID-19.

methodsA systematic literature search of RCTS and observational studies on adult patients was performed across Medline/PubMed, Embase and Web of Science from December 1, 2019, until October 1, 2020, according to the PRISMA guidelines. Primary outcomes were short-term mortality and viral clearance (based on RT-PCR in respiratory specimens). Secondary outcomes were: need for mechanical ventilation, need for other oxygen therapy, length of hospital stay and secondary infections.

resultsForty-four studies were included, covering 20.197 patients. In twenty-two studies, the effect of corticosteroid use on mortality was quantified. The overall pooled estimate (observational studies and RCTs) showed a significant reduced mortality in the corticosteroid group (OR 0.72 (95%CI 0.57-0.87). Furthermore, viral clearance time ranged from 10 to 29 days in the corticosteroid group and from 8 to 24 days in the standard of care group. Fourteen studies reported a positive effect of corticosteroids on need for and duration of mechanical ventilation. A trend toward more infections and antibiotic use was present.

conclusionsOur findings from both observational studies and RCTs confirm a beneficial effect of corticosteroids on short-term mortality and a reduction in need for mechanical ventilation. And although data in the studies were too sparse to draw any firm conclusions, there might be a signal of delayed viral clearance and an increase in secondary infections.

Indexed as

COVID-19 Drug TreatmentAdrenal Cortex HormonesAdultCOVID-19Hospital MortalityHumansLength of StayAdrenal Cortex HormonesCoronavirusCorticosteroidsCOVID-19Mechanical ventilationMortalitySARS-CoV-2Viral clearance

Identifiers

PMID33317589
PMCPMC7735177

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.