Hydroxychloroquine has been promoted for its use in treatment of COVID-19 patients based on in-vitro evidences. We searched the databases to include randomized and observational studies evaluating the effect of Hydroxychloroquine on mortality in COVID-19 patients. The outcome was summarized as odds ratios (OR) with a 95% confidence interval (CI).We used the inverse-variance method with a random effect model and assessed the heterogeneity using I² test. We used ROBINS-I tool to assess methodological quality of the included studies. We performed the meta-analysis using ‘Review manager software version 5.3’. We identified 6 observationalstudies satisfying the selection criteria. In all studies, Hydroxychloroquine was given as add on to the standard care and effect was compared with the standard care alone. A pooled analysis observed 251 deaths in 1331 participants of the Hydroxychloroquine arm and 363 deaths in 1577 participants of the control arm. There was no difference in odds of mortality events amongst Hydroxychloroquine and supportive care arm [1.25 (95% CI: 0.65, 2.38); I² = 80%]. A similar trend was observed with moderate risk of bias studies [0.95 (95% CI: 0.44, 2.06); I² = 85%]. The odds of mortality were significantly higher in patients treated with Hydroxychloroquine + Azithromycin than supportive care alone [2.34 (95% CI: 1.63, 3.34); I² = 0%]. A pooled analysis of recently published studies suggests no additional benefit for reducing mortality in COVID-19 patients when Hydroxychloroquine is given as add-on to the standard care.

Graphical Abstract

中文翻译：

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在标准护理中添加羟氯喹是否对降低 COVID-19 患者的死亡率有任何好处？：系统评价。

基于体外证据，羟氯喹已被推广用于治疗 COVID-19 患者。我们搜索了数据库，纳入了评估羟氯喹对 COVID-19 患者死亡率影响的随机和观察性研究。结果总结为具有 95% 置信区间 (CI) 的优势比 (OR)。我们使用具有随机效应模型的逆方差方法并使用 I ^{2评估异质性}测试。我们使用 ROBINS-I 工具来评估纳入研究的方法学质量。我们使用“Review manager software version 5.3”进行了荟萃分析。我们确定了 6 个满足选择标准的观察性研究。在所有研究中，羟氯喹作为标准护理的补充，并将效果与单独的标准护理进行比较。一项汇总分析观察到羟氯喹组的 1331 名参与者中有 251 人死亡，而对照组的 1577 名参与者中有 363 人死亡。羟氯喹和支持治疗组的死亡事件几率没有差异 [1.25 (95% CI: 0.65, 2.38)；我²  = 80%]。在中等偏倚风险研究中观察到了类似的趋势 [0.95 (95% CI: 0.44, 2.06)；我² = 85%]。接受羟氯喹+阿奇霉素治疗的患者的死亡率显着高于单独支持治疗的患者 [2.34 (95% CI: 1.63, 3.34)；我²  = 0%]。对最近发表的研究的汇总分析表明，当羟氯喹作为标准护理的附加物时，对降低 COVID-19 患者的死亡率没有额外的好处。

图形概要