The effect of corticosteroid therapy is still controversial on prevention of mortality in coronavirus disease‐2019 (COVID‐19). The objective of this study is to investigate the effect of corticosteroids on mortality. This systematic review was performed as per preferred reporting items for systematic reviews and meta‐analyses guidelines. A systematic search was performed at different databases namely Medline/PubMed, Cochrane and Google scholar on 10 February 2022. A pooled estimate for effect of corticosteroid therapy on mortality was calculated as outcome of study. Risk bias analysis and Newcastle Ottawa Scale were used to assess the quality of randomized control trial (RCT) and cohort studies, respectively. Cochran's Q test and the I2 statistic were conducted for heterogeneity and accordingly study model was applied. A total 43 studies were included, having sample size of 96,852 patients. Amongst them, 19,426 and 77,426 patients received corticosteroid therapy (intervention group) or standard treatment without corticosteroid (control group), respectively. Mortality observed in the intervention and control group was 14.2% (2749) and 7.1% (5459), respectively. The pooled estimate 2.173 (95% CI: 2.0690–2.2820) showed significantly increased mortality in intervention as compared to control. The pooled estimate of methyprednisolone 1.206 (95% CI: 1.0770–1.3500) showed significantly increased mortality while the pooled estimate of dexamethasone 1.040 (95% CI: 0.9459–1.1440) showed insignificantly increased mortality as compared to control. In conclusion, corticosteroid therapy produced a negative prognosis as depicted by increased mortality among COVID‐19 patients. The possible reasons might be delay in virus clearance and secondary infections due to corticosteroids initiated at high dose in the early stage of infection.

Background and Purpose: Corticosteroid therapy is still controversial to use for treatment of coronavirus disease-2019 (COVID-19). The results of multiple randomized clinical trials (RCTs) and observational studies are very diverse and contradictory, which arising difficulty in the clinical decision-making. The objective of this study is to investigate the effect of corticosteroids on mortality by systematic review and meta-analysis. External Approach: A systematic search was performed on different databases namely Medline/PubMed, Cochrane and Google scholar on 10 February 2022, according to PRISMA guidelines. The 28-days mortality was considered as outcome of study. A pooled estimate was calculated with random effects and fixed effects models. Cochran’s Q test and the I2 statistic were conducted for statistical heterogeneity. Key Results: 38 studies were included, having sample size of 87,781 patients. Amongst them, 16437 patients received corticosteroid therapy (intervention group) while 71344 patients were standard (noncorticosteroids) therapy (control group). 12.68% (2084) mortality observed in the intervention group while 5.93% (4227) mortality observed in the control group. The overall pooled estimate showed a significantly (OR2.305;95%CI: 2.1810 to 2.4370) increased mortality in intervention group. A pooled fold change estimation showed significantly increased in the mortality in methylprednisolone (OR 1.206;95%CI: 1.0770 to 1.3500) and dexamethasone (OR 1.388;95% CI:1.1870 to 1.6220) therapy. Conclusion and Implication: In conclusion, corticosteroid therapy produced a negative prognosis as depicted by increased mortality among COVID-19 patients. The possible reasons might be delay in virus clearance and secondary infection due to initiation of the corticosteroids at high dose in the early stage of infection.