Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis

Abstract

Objectives: The acute respiratory distress syndrome (ARDS) secondary to viral pneumonitis is one of the main causes of high mortality in patients with COVID-19 (novel coronavirus disease 2019). We systematically reviewed mortality in COVID-19 patients with ARDS and the potential role of systemic corticosteroids in COVID-19 patients. Methods: Electronic databases and country-specific healthcare databases were searched to identify relevant studies/reports. The quality assessment of individual studies was conducted using the Newcastle-Ottawa Scale. Country-specific proportion of individuals with COVID-19 who developed ARDS and reported death were combined in a random-effect meta-analysis to give a pooled mortality estimate of ARDS. Results: The overall pooled mortality estimate among 10,815 ARDS cases in COVID-19 patients was 39% (95% CI: 23-56%). The pooled mortality estimate for China was 69% (95% CI: 67-72%). In Europe, the highest mortality estimate among COVID-19 patients with ARDS was reported in Poland (73%; 95% CI: 58-86%) while Germany had the lowest mortality estimate (13%; 95% CI: 2-29%) among COVID-19 patients with ARDS. The median crude mortality rate of COVID-19 patients with reported corticosteroid use was 28.0% (lower quartile: 13.9%; upper quartile: 53.6%). Conclusions: The high mortality in COVID-19 associated ARDS necessitates a prompt and aggressive treatment strategy which includes corticosteroids. Most of the studies included no information on the dosing regimen of corticosteroid therapy, however, low-dose corticosteroid therapy or pulse corticosteroid therapy appears to have a beneficial role in the management of severely ill COVID-19 patients.

Prevalence of diabetes, management and outcomes among Covid-19 adult patients admitted in a specialized tertiary hospital in Riyadh, Saudi Arabia

“…The use of hydroxychloroquine however in Saudi Arabia is approved by the Ministry of Health. The use of corticosteroids on the other hand has been an established treatment for patients with acute respiratory distress syndrome (ARDS) and other acute lung diseases for immediate immunosuppressive effect, given as either low dose or pulse therapy [22,23]. Dexamethasone in particular was the only drug in the present study that significantly improved the final outcome of patients based on NRI and IDI analysis.…”

Preliminary predictive criteria for COVID-19 cytokine storm

“…Acute respiratory distress syndrome (ARDS) is undeniably one of the most lethal manifestations of COVID-19 infection. 36 The abnormal laboratory work in our criteria could be explained by ARDS in which both hypoxia and hyperaemia could drive elevation of LDH, liver enzymes and renal dysfunction with albumin levels as predictor of ARDS. 37 38 Nevertheless, a significant number of immunoprofiling results point to a systemic inflammatory response with the lung at the epicentre.…”

Mortality and Disease Severity Among COVID-19 Patients Receiving Renin-Angiotensin System Inhibitors: A Systematic Review and Meta-analysis

“…Equally interesting is the observation that hypertensive ACEI/ARB users had a lower risk of death and a lower risk of developing severe/critical disease from COVID-19 compared to hypertensive non-ACEI/ARB users. One explanation for such observations is that RAS inhibitors may be able to protect COVID-19 patients from angiotensin II-related lung injury and subsequent ARDS, the major cause of mortality in COVID-19 patients [104]. However, since the definition of severe/critical illness in our meta-analysis did not specifically include ARDS, such a protective effect was not reflected in the risk of developing severe/critical illness in our analysis.…”