Severity and Mortality Associated with Steroid Use among Patients with COVID-19: A Systematic Review and Meta-Analysis

Abstract

Background. There are controversial suggestions about steroid use to treat patients infected with COVID-19. Conclusive evidence regarding the use of steroids to treat COVID-19 is still lacking. This meta-analysis aimed to determine the mortality and severity associated with corticosteroid therapy compared to noncorticosteroid treatment in patients with COVID-19. Methods. The information was collected from electronic databases: PubMed, CINAHL, the Cochrane Library, clinicaltrials.gov, and Google scholar through January 30, 2021. Risk ratios (RRs) with 95% confidence intervals (CIs) were performed using random effect models. Endnote citation manager software version X9 for Windows was utilized to collect and organize search outcomes (into relevant and irrelevant studies) and to remove duplicate articles. Results. Thirty-two studies were included in the meta-analysis, including 14,659 COVID-19 patients. No significant differences in mortality between the steroid and nonsteroid treatment groups (RR = 0.95; 95% CI: 0.80–1.13; p = 0.57). There was no significant reduction in mortality in critically ill COVID-19 patients treated with corticosteroid (RR = 0.89; 95% CI: 0.62–1.27; p = 0.52). Significant differences were observed in severe disease conditions between the steroid and nonsteroid treatment groups (RR = 1.10; 95% CI, 1.03–1.19, p = 0.007). Conclusion. There was no significant difference in all-cause mortality between the steroid and nonsteroid treatment users’ of COVID-19 patients. There was no significant reduction of all-cause mortality in critically ill COVID-19 patients treated with corticosteroids.

Increasing Mortality in Venovenous Extracorporeal Membrane Oxygenation for COVID-19–Associated Acute Respiratory Distress Syndrome

“…In a retrospective study of 441 patients conducted prior to the COVID-19 pandemic, Kim et al ( 10 ) reported that steroid use was independently associated with increased inhospital mortality in patients successfully weaned off steroids. In addition, further analysis regarding corticosteroid use in COVID-19 remains inconclusive ( 11 ). Overall, we believe that these findings suggest that the role of steroids for COVID-19 ARDS requires additional analysis before the utilization of this therapy is confirmed in this setting.…”

In-hospital mortality in SARS-CoV-2 stratified by the use of corticosteroid

“…A systematic review and meta-analysis showed no mortality benefit with the use of corticosteroids when compared to those not on corticosteroids. [ 31 ]. A UK based study has shown a mortality benefit when corticosteroids are administered to patients on invasive mechanical ventilators.…”

Inpatient Administration of Alpha-1-Adrenergic Receptor Blocking Agents Reduces Mortality in Male COVID-19 Patients

“…For comparison, the equivalent to the RECOVERY trial dosing of 6 mg dexamethasone is 20-30 mg of methylprednisolone ( 16 ). Furthermore, corticosteroids were associated with an increased risk of death in patients younger than 60 years without inflammation on admission ( 17 ). Thus, the observed effect of steroids in this real-world study may diverge from the effect reported in randomized trials due to factors such as inconsistent dosing, steroid choice, and patient selection early in the pandemic.…”