Meta-analysis and systematic review: The administration of glucocorticoids, as a line of treatment for COVID-19 patients, could result in lowering mortality

Abstract

The aim of this meta-analysis was to investigate the association between the use of glucocorticoids and the mortality of covid-19 patients. Trials were identified through a comprehensive systematic search of four medical databases including PubMed, Cochrane Library, Web of Science, and Embase. We also searched for relevant papers using the Google search engine and major Preprint platforms including Medrix, bioRxiv, and SSRN. A meta-analysis was performed on the pooled results of these studies. Fourteen studies were enrolled. Five studies were Chinese, and nine were foreign. In the foreign studies, we found use of steroids was associated with a decrease in mortality (RR, 0.81; 95% CI 0.68–0.97; p = 0.02) whilst in the Chinese studies the use of steroids was associated with an increase in mortality (RR, 1.70; 95% CI 1.10–2.63; p = 0.02). The foreign studies included high-dose and medium-dose groups. The medium-dose glucocorticoid group (0.5 mg/kg/d ≤ Prednisone ≤ 1.0 mg/kg/d) showed an association with decreased mortality of covid-19 patients (RR 0.86; 95% CI 0.75–1.00; p = 0.05). We also found an association with decreasing mortality of covid-19 patients (RR 0.65; 95% CI 0.43–0.98; heterogeneity p = 0.04) in patients treated for ≤ five days. In summary, this meta-analysis demonstrated that the use of a medium dose of glucocorticoids for a short time is likely to decrease mortality, although this needs clinical confirmation.

Keywords:

• meta-analysis
• glucocorticoids
• mortality
• covid-19 patients

PUBLIC INTEREST STATEMENT

The aim of this meta-analysis was to investigate the association between the use of glucocorticoids and the mortality of covid-19 patients. We did a comprehensive systematic search of four medical databases including PubMed, Cochrane Library, Web of Science, Embase, and major preprint platforms including Medrix, bioRxiv, and SSRN. Fourteen studies were enrolled. We demonstrated a positive correlation between survival of covid-19 patients and use of steroids: a medium dose use of glucocorticoids for a short time being more likely to decrease mortality. At the same time, giving a medium dose use of steroids for a short time has little risk of side effects for covid-19 patients. But, questions such as indication, time of onset and duration of steroids need to be better clarified in well-designed quantitative trials.

Acknowledgements

The authors thank the First Affiliated Hospital of Chongqing Medical University.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data generated or analyzed during this study are included in this article.

Statement of ethics

This study is a meta-analysis, and all analyses are based on previously published studies; thus, no ethical approval and patient consent are required.

Correction

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

No funding was received.

Notes on contributors

Zhou Enhao

Zhou Enhao, Li You, and Yang Chun designed this research, Zhou Enhao, Li You, Hu Danlan, and Dai Yuchi searched clinical articles from four medical databases including PubMed, Cochrane Library, Web of Science, and Embase and also researched relevant papers using the Google search engine and major Preprint platforms including Medrix, bioRxiv, and SSRN. Zhou Enhao and Li You did some meta-analysis work via Revman 5.4 and wrote this article. Yang Chun revised this article and gave some useful suggestions.