To evaluate the efficacy of corticosteroids on coronavirus disease 2019 (COVID-19) patients with different levels of disease severity. In our multicenter study, 543 patients with confirmed COVID-19 were classified as non-severe group and severe group, and then were compared respectively for all-cause mortality and length of hospital stay between those who received corticosteroids and not. By searching in PubMed, Web of Science, Embase, and CNKI, we identified 13 retrospective studies and 6 random control trials eligible for criteria of inclusion, and conducted comprehensive meta-analyses assessing the impacts of corticosteroids on mortality, length of stay, duration of RNA clearance and duration of fever. Our multicenter study demonstrated that low-dose corticosteroids can reduce mortality in the multivariable Cox regression analysis for severe patients (p = .03), while presented no influence in univariable analysis for non-severe patients (p = .14). From multivariable analyses, patients with corticosteroids in non-severe group had longer duration of hospitalization (p = .003), but did not in severe group (p = .18). Moreover, for severe patients, corticosteroids can evidently shorten duration of fever. The same results were summarized in the meta-analyses supplemented with the result that corticosteroids delayed viral clearing in non-severe patients. Corticosteroids should be considered based on patient's condition. For patients with non-severe COVID-19, corticosteroid was not recommended as a routine therapeutic initiative as that presented prolonged duration of hospitalization and delayed viral clearing, as well as no positive impact on prognosis. While low-dose corticosteroids may benefit patients with severe COVID-19 for it can manifestly lower risk of death and improve the clinical status to some extent.
基金:
National key basic research and development program [20l5CB553403]; National Key RAMP;D Program of China [2016YFC1304500, 2018YFC1311900]; National Natural Science Foundation of China [81570033, 81973986]
第一作者单位:[1]Huazhong Univ Sci & Technol, Tongji Hosp, Dept Resp & Crit Care Med, Natl Clin Res Ctr Resp Dis,Tongji Med Coll, Wuhan, Peoples R China
通讯作者:
通讯机构:[1]Huazhong Univ Sci & Technol, Tongji Hosp, Dept Resp & Crit Care Med, Natl Clin Res Ctr Resp Dis,Tongji Med Coll, Wuhan, Peoples R China[*1]Huazhong Univ Sci & Technol, Tongji Hosp, Dept Resp & Crit Care Med, Tongji Med Coll, 1095 Jiefang Ave, Wuhan 430030, Hubei, Peoples R China
推荐引用方式(GB/T 7714):
Zhan Yuan,Shang Jin,Gu Yiya,et al.Efficacy of corticosteroid in patients with COVID-19: A multi-center retrospective study and meta-analysis[J].JOURNAL OF MEDICAL VIROLOGY.2021,93(7):4292-4302.doi:10.1002/jmv.26914.
APA:
Zhan, Yuan,Shang, Jin,Gu, Yiya,Huang, Qian&Xie, Jungang.(2021).Efficacy of corticosteroid in patients with COVID-19: A multi-center retrospective study and meta-analysis.JOURNAL OF MEDICAL VIROLOGY,93,(7)
MLA:
Zhan, Yuan,et al."Efficacy of corticosteroid in patients with COVID-19: A multi-center retrospective study and meta-analysis".JOURNAL OF MEDICAL VIROLOGY 93..7(2021):4292-4302