Corticosteroids in COVID-19: Is it Rational? A Systematic Review and Meta-Analysis
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COVID-19
Corticosteroids in COVID-19: Is it Rational? A Systematic Review and Meta-Analysis Pravash Budhathoki 1
&
Dhan Bahadur Shrestha 2
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Era Rawal 3
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Sitaram Khadka 4
Accepted: 9 September 2020 # Springer Nature Switzerland AG 2020
Abstract Due to a lack of definitive treatment, many drugs were repurposed for Coronavirus disease (COVID-19) treatment; among them, corticosteroid is one. However, its benefit or harm while treating COVID-19 is not fully studied. Thus, we conducted this meta-analysis to assess the rationality on the use of corticosteroids in COVID-19. Pubmed, Medline, Clinicaltrials.gov, Cochrane library, and Preprint publisher were searched. In the qualitative syntheses, 41, and quantitative studies, 40, were included using PRISMA guidelines. Assessment of heterogeneity was done using the I-squared (I2) test and random/fixed effect analysis was done to determine the odds/risk ratio. We found severely ill COVID-19 patients almost 5 (OR 4.78, 2.76–8.26) times higher odds of getting corticosteroids during their treatment. Similarly, the odds for corticosteroids in addition to standard of care (SOC) were approximately 4 (OR 4.09, 1. 89–8.84) times higher among intensive care unit (ICU) patients than non-ICU ones. A higher mortality risk with the corticosteroidreceiving group compared with the SOC alone (RR 2.01, 1.12–3.63) was observed. Neither increased discharge rate (RR 0.79, 0.63–0. 99) nor recovery/improvement rate was shown among the corticosteroid-receiving group (OR 0.24, 0.13–0.43). Approximately, the overall 4-day longer hospital stay was found among the treatment groups (MD 4.19, 2.57–5.81). For the negative conversion of reverse transcription–polymerase chain reaction (RT-PCR), approximately a 3-day (MD 2.42, 1.31–3.53) delay was observed with corticosteroid treatment cases. Our study concludes that more severe and critically ill patients tend to get corticosteroids, and the mortality risk increases with the use of corticosteroids. With the use of corticosteroids, delayed recovery and a longer hospital stay were observed. Keywords COVID-19 . Critical illness . Length of stay . Patient discharge . Survival rate
Background An unprecedented outbreak of pneumonia of unknown etiology in Wuhan City, Hubei province in China emerged in December 2019. A novel coronavirus was identified as the This article is part of the Topical Collection on COVID-19 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s42399-020-00515-6) contains supplementary material, which is available to authorized users. * Sitaram Khadka [email protected] 1
Dr Iwamura Memorial Hospital, Bhaktapur 44800, Nepal
2
Department of Emergency Medicine, Mangalbare Hospital, Morang, Ulrabari 56600, Nepal
3
Department of Emergency Medicine, Kathmandu Medical College, Kathmandu 44600, Nepal
4
Department of Pharmacy, Shree Birendra Hospital, Nepalese Army Institute of Health Sciences, Kathmandu 44600, Nepal
causative agent and was subsequently termed Coronavirus disease
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