The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis

  • Author Footnotes
    1 The authors contributed equally to this work.
    Zhenwei Yang
    Footnotes
    1 The authors contributed equally to this work.
    Affiliations
    Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China

    Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
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  • Author Footnotes
    1 The authors contributed equally to this work.
    Jialong Liu
    Footnotes
    1 The authors contributed equally to this work.
    Affiliations
    Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China

    Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
    Search for articles by this author
  • Yunjiao Zhou
    Affiliations
    Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China

    Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
    Search for articles by this author
  • Xixian Zhao
    Affiliations
    Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China

    Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
    Search for articles by this author
  • Qiu Zhao
    Affiliations
    Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China

    Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
    Search for articles by this author
  • Jing Liu
    Correspondence
    Corresponding author.
    Affiliations
    Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China

    Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan 430071, China
    Search for articles by this author
  • Author Footnotes
    1 The authors contributed equally to this work.
Published:April 10, 2020DOI:https://doi.org/10.1016/j.jinf.2020.03.062

      Highlights

      • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) threatens the health of people, and there is no proven pharmacological treatment.
      • Although corticosteroids were widely used during outbreaks of severe acute respiratory syndrome and Middle East respiratory syndrome, their efficacy remains highly controversial.
      • Patients with severe conditions are more likely to require corticosteroids. However, corticosteroid use may lead to increased mortality and serious adverse reactions.
      • Therefore, corticosteroids should be used with caution in the treatment of coronavirus disease 2019 (COVID-19).

      Abstract

      Objectives

      An outbreak of novel coronavirus in 2019 threatens the health of people, and there is no proven pharmacological treatment. Although corticosteroids were widely used during outbreaks of severe acute respiratory syndrome and Middle East respiratory syndrome, their efficacy remainedhighly controversial. We aimed to further evaluate the influence of corticosteroids on patients with coronavirus infection.

      Methods

      We conducted a comprehensive search of literature published in PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure (CNKI) from January 1, 2002 to March 15, 2020. All statistical analyses in this study were performed on stata14.0.

      Results

      A total of 5270 patients from 15 studies were included in this meta-analysis. The result indicated that critical patients were more likely to require corticosteroids therapy (risk ratio [RR] = 1.56, 95% confidence interval [CI] = 1.28-1.90, P<0.001). However, corticosteroid treatment was associated with higher mortality (RR = 2.11, 95%CI = 1.13-3.94, P = 0.019), longer length of stay (weighted mean difference [WMD] = 6.31, 95%CI = 5.26–7.37, P<0.001), a higher rate of bacterial infection (RR = 2.08, 95%CI = 1.54–2.81, P<0.001), and hypokalemia (RR = 2.21, 95%CI = 1.07–4.55, P = 0.032) but not hyperglycemia (RR = 1.37, 95%CI=0.68–2.76, P = 0.376) or hypocalcemia (RR = 1.35, 95%CI = 0.77–2.37, P = 0.302).

      Conclusions

      Patients with severe conditions are more likely to require corticosteroids. Corticosteroid use is associated with increased mortality in patients with coronavirus pneumonia.

      Keywords

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