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Corticosteroids on the Management of Coronavirus Disease 2019 (COVID-19): A Systemic Review and Meta-Analysis
Iranian Journal of Public Health ( IF 1.3 ) Pub Date : 2020-08-05 , DOI: 10.18502/ijph.v49i8.3863
Mahmoud Yousefifard 1 , Kosar Mohamed Ali 2 , Abbas Aghaei 3 , Alireza Zali 4 , Arian Madani Neishaboori 1 , Afshin Zarghi 5 , Saeed Safari 6, 7 , Behrooz Hashemi 7 , Mohammad Mehdi Forouzanfar 7 , Mostafa Hosseini 8
Affiliation  

Background: We aimed to examine the available evidence regarding the efficacy and safety of corticosteroids on the management of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV). Method: An extensive search was conducted in Medline, Embase, and Central databases until the end of March 2020, using keywords related to corticosteroids, COVID-19, SARS-CoV and MERS-CoV. The main outcome was considered to be the mortality rate, length of stay, virus clearance time, symptom improvement, and lung function improvement. The findings are presented as odds ratio (OR) with 95% confidence interval (95% CI). Results: Fifteen paper compromising 5 studies on COVID-19, 8 studies on SARS-CoV and 2 studies on MERS-CoV were included. One study was clinical trial and the rest were cohort. The analyses showed that corticosteroids were not reduce the mortality rate of COVID-19 (OR=1.08; 95% CI: 0.34 to 3.50) and SARS-CoV (OR=0.77; 95% CI: 0.34 to 1.3) patients, while they were associated with higher mortality rate of patients with MERS-CoV (OR = 2.52; 95% CI: 1.41 to 4.50). Moreover, it appears that corticosteroids administration would not be effective in shortening viral clearance time, length of hospitalization, and duration of relief symptoms following viral severe acute respiratory infections. Conclusion: There is no evidences that corticosteroids are safe and effective on the treatment of severe acute respiratory infection when COVID-19 disease is suspected. Therefore, corticosteroids prescription in COVID-19 patients should be avoided.

中文翻译:

皮质类固醇治疗 2019 年冠状病毒病 (COVID-19):系统回顾和荟萃分析

背景:我们旨在检查有关皮质类固醇治疗 2019 年冠状病毒病 (COVID-19)、严重急性呼吸综合征 (SARS-CoV) 和中东呼吸综合征 (MERS-CoV) 的有效性和安全性的现有证据。方法:使用与皮质类固醇、COVID-19、SARS-CoV 和 MERS-CoV 相关的关键字,在 Medline、Embase 和 Central 数据库中进行了广泛搜索,直至 2020 年 3 月。主要结果被认为是死亡率、住院时间、病毒清除时间、症状改善和肺功能改善。结果显示为具有 95% 置信区间 (95% CI) 的优势比 (OR)。结果:15 篇论文涉及 5 项关于 COVID-19 的研究、8 项关于 SARS-CoV 的研究和 2 项关于 MERS-CoV 的研究。一项研究是临床试验,其余的是队列研究。分析表明,皮质类固醇并未降低 COVID-19(OR=1.08;95% CI:0.34 至 3.50)和 SARS-CoV(OR=0.77;95% CI:0.34 至 1.3)患者的死亡率,而与 MERS-CoV 患者较高的死亡率相关(OR = 2.52;95% CI:1.41 至 4.50)。此外,似乎皮质类固醇给药在缩短病毒清除时间、住院时间和病毒性严重急性呼吸道感染后缓解症状的持续时间方面无效。结论:当怀疑 COVID-19 疾病时,没有证据表明皮质类固醇治疗严重急性呼吸道感染是安全有效的。因此,应避免在 COVID-19 患者中使用皮质类固醇。08; 95% CI:0.34 至 3.50)和 SARS-CoV(OR=0.77;95% CI:0.34 至 1.3)患者,而它们与 MERS-CoV 患者较高的死亡率相关(OR = 2.52;95% CI: 1.41 至 4.50)。此外,似乎皮质类固醇给药在缩短病毒清除时间、住院时间和病毒性严重急性呼吸道感染后缓解症状的持续时间方面无效。结论:当怀疑 COVID-19 疾病时,没有证据表明皮质类固醇治疗严重急性呼吸道感染是安全有效的。因此,应避免在 COVID-19 患者中使用皮质类固醇。08; 95% CI:0.34 至 3.50)和 SARS-CoV(OR=0.77;95% CI:0.34 至 1.3)患者,而它们与 MERS-CoV 患者较高的死亡率相关(OR = 2.52;95% CI: 1.41 至 4.50)。此外,似乎皮质类固醇给药在缩短病毒清除时间、住院时间和病毒性严重急性呼吸道感染后缓解症状的持续时间方面无效。结论:当怀疑 COVID-19 疾病时,没有证据表明皮质类固醇治疗严重急性呼吸道感染是安全有效的。因此,应避免在 COVID-19 患者中使用皮质类固醇。50)。此外,似乎皮质类固醇给药在缩短病毒清除时间、住院时间和病毒性严重急性呼吸道感染后缓解症状的持续时间方面无效。结论:当怀疑 COVID-19 疾病时,没有证据表明皮质类固醇治疗严重急性呼吸道感染是安全有效的。因此,应避免在 COVID-19 患者中使用皮质类固醇。50)。此外,似乎皮质类固醇给药在缩短病毒清除时间、住院时间和病毒性严重急性呼吸道感染后缓解症状的持续时间方面无效。结论:当怀疑 COVID-19 疾病时,没有证据表明皮质类固醇治疗严重急性呼吸道感染是安全有效的。因此,应避免在 COVID-19 患者中使用皮质类固醇。当怀疑 COVID-19 疾病时,没有证据表明皮质类固醇对治疗严重急性呼吸道感染是安全有效的。因此,应避免在 COVID-19 患者中使用皮质类固醇。当怀疑 COVID-19 疾病时,没有证据表明皮质类固醇对治疗严重急性呼吸道感染是安全有效的。因此,应避免在 COVID-19 患者中使用皮质类固醇。
更新日期:2020-08-05
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