PDF(Pubmed)
Abstract：
In the realm of acute respiratory infections, coronavirus disease-19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), poses a global public health challenge. The application of corticosteroids (CSs) in COVID-19 remains a contentious topic among researchers. Accordingly, our team performed a comprehensive meta-analysis of randomized controlled trials (RCTs) to meticulously evaluate the safety and efficacy of CSs in hospitalized COVID-19 patients. To explore efficacy of CSs in the treatment of COVID-19 patients, we meticulously screened RCTs across key databases, including PubMed, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov, as well as China\'s CNKI and Wanfang Data. We focused on assessing the 28 days mortality rates. We evaluated the data heterogeneity using the Chi-square test and I2 values, setting significance at 0.1 and 50%. Data from 21 RCTs involving 5721 participants were analyzed. The analysis did not demonstrate a significant association between CSs intervention and the 28 days mortality risk in hospitalized COVID-19 patients (relative risk [RR] = 0.93; 95% confidence interval [95% CI]: 0.84-1.03; P = 0.15). However, subgroup analysis revealed a significant reduction in 28 days mortality among patients with moderate-to-severe COVID-19 (RR at 0.85; 95% CI: 0.76-0.95; P = 0.004). Specifically, short-term CS administration (≤ 3 days) was associated with a substantial improvement in clinical outcomes (RR = 0.24; 95% CI: 0.09-0.63; P = 0.004), as was longer-term use (≥ 8 days) (RR = 0.88; 95% CI: 0.77-0.99; P = 0.04). Additionally, in patients with moderate-to-severe COVID-19, the administration of dexamethasone increased the number of 28 days ventilator-free days (Mean Difference = 1.92; 95% CI: 0.44-3.40; P = 0.01). Methylprednisolone also demonstrated significant benefits in improving clinical outcomes (RR = 0.24; 95% CI: 0.09-0.63; P = 0.004). Our meta-analysis demonstrated that although there is no significant difference in 28 days mortality rates among hospitalized COVID-19 patients, the use of CSs may be beneficial in improving clinical outcomes in moderate or severe COVID-19 patients. There was no significant increase in the occurrence of adverse events associated with the use of CSs. Our meta-analysis provides evidence that while CSs may not be suitable for all COVID-19 patients, they could be effective and safe in severely ill COVID-19 patients. Consequently, it is recommended to administer CSs for personalized treatments in COVID-19 cases to improve the clinical outcomes while minimizing adverse events.
摘要：
在急性呼吸道感染领域，冠状病毒病-19（COVID-19），由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，构成全球公共卫生挑战。皮质类固醇（CSs）在COVID-19中的应用仍然是研究人员的争议话题。因此，我们的团队对随机对照试验(RCTs)进行了全面的荟萃分析,以仔细评估CSs在住院COVID-19患者中的安全性和有效性.探讨CSs治疗COVID-19的疗效,我们仔细筛选了关键数据库的RCT，包括PubMed,WebofScience,Embase,科克伦图书馆,ClinicalTrials.gov,以及中国CNKI和万方数据。我们专注于评估28天死亡率。我们使用卡方检验和I2值评估了数据异质性，将显著性设置为0.1%和50%。分析了涉及5721名参与者的21个RCT的数据。分析未显示CSs干预与住院COVID-19患者28天死亡风险之间存在显著关联(相对风险[RR]=0.93；95%置信区间[95%CI]：0.84-1.03；P=0.15)。然而,亚组分析显示,中重度COVID-19患者28日死亡率显著降低(RR为0.85;95%CI:0.76~0.95;P=0.004).具体来说,短期CS给药（≤3天）与临床结局的实质性改善相关（RR=0.24;95％CI：0.09-0.63;P=0.004），长期使用(≥8天)(RR=0.88;95%CI:0.77-0.99;P=0.04).此外,在中重度COVID-19患者中,给予地塞米松增加了28天的无呼吸机天数(平均差=1.92;95%CI:0.44~3.40;P=0.01).甲基强的松龙在改善临床结局方面也显示出显著的益处(RR=0.24;95%CI:0.09-0.63;P=0.004)。我们的荟萃分析表明，尽管住院COVID-19患者的28天死亡率没有显着差异，CSs的使用可能有利于改善中度或重度COVID-19患者的临床结局.与使用CSs相关的不良事件发生率没有显著增加。我们的荟萃分析提供了证据，尽管CSs可能不适合所有COVID-19患者，它们在重症COVID-19患者中可能是有效和安全的。因此,建议在COVID-19病例的个性化治疗中使用CSs,以改善临床结局,同时将不良事件降至最低.
