INTRODUCTION We conducted a comprehensive literature review to synthesize evidence for the relationship between corticosteroid use and mortality in patients with COVID-19. METHODS The PUBMED, EMBASE, and Cochrane Library were searched from inception to March 13, 2021. We searched and analyzed randomized controlled trials (RCTs) and observational studies (OSs) that examined corticosteroid use in patients with COVID-19. The primary outcome was in-hospital mortality, while the secondary outcome was the need for mechanical ventilation (MV) and serious adverse events. RESULTS A total of 11 RCTs and 44 OSs involving 7893 and 41,164 patients with COVID-19 were included in the study. Corticosteroid use was associated with lower COVID-19 mortality in RCTs, but was not statistically significant (OR 0.91, 95% CI 0.77-1.07; I2 = 63.4%). The subgroup analysis of pulse dose corticosteroid showed survival benefit statistically (OR 0.29, 95% CI 0.15-0.56). Moreover, the corticosteroid use may reduce the need for MV (OR 0.67, 95% CI 0.51-0.90; I2 = 7.5%) with no significant increase in serious adverse reactions (OR 0.84, 95% CI 0.30-2.37; I2 = 33.3%). In addition, the included OSs showed that the pulse dose (OR 0.66, 95% CI 0.45-0.95; I2 = 30.8%) might lower the mortality in patients with COVID-19. The pulse dose of methylprednisolone (OR 0.60, 95% CI 0.45-0.80; I2 = 0%) had a beneficial effect on survival. It was especially significant when the duration of pulse methylprednisolone use was less than 7 days (OR 0.59, 95% CI 0.43-0.80; I2 = 0%). CONCLUSIONS This meta-analysis indicated that corticosteroid use might cause a slight reduction in COVID-19 mortality. However, it could significantly reduce the MV requirement in patients with COVID-19 and restrict serious adverse events. Additionally, the pulse dose of methylprednisolone for less than 7 days may be a good treatment choice for patients with COVID-19.

中文翻译：

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皮质类固醇在 2019 年冠状病毒病 (COVID-19) 中使用的有效性和安全性：系统评价和荟萃分析。

引言 我们进行了全面的文献回顾，以合成 COVID-19 患者皮质类固醇使用与死亡率之间关系的证据。方法 PUBMED、EMBASE 和 Cochrane 库从开始到 2021 年 3 月 13 日进行了搜索。我们搜索并分析了检查 COVID-19 患者使用皮质类固醇的随机对照试验 (RCT) 和观察性研究 (OS)。主要结果是院内死亡率，而次要结果是机械通气 (MV) 和严重不良事件的需要。结果 本研究共纳入 11 项 RCT 和 44 项 OS，涉及 7893 和 41164 名 COVID-19 患者。在 RCT 中，皮质类固醇的使用与较低的 COVID-19 死亡率相关，但没有统计学意义（OR 0.91，95% CI 0.77-1.07；I2 = 63.4%）。脉冲剂量皮质类固醇的亚组分析显示出统计学上的生存获益（OR 0.29，95% CI 0.15-0.56）。此外，皮质类固醇的使用可能会减少对 MV 的需求（OR 0.67，95% CI 0.51-0.90；I2 = 7.5%），而严重不良反应没有显着增加（OR 0.84，95% CI 0.30-2.37；I2 = 33.3%） ）。此外，纳入的 OS 显示脉冲剂量（OR 0.66，95% CI 0.45-0.95；I2 = 30.8%）可能会降低 COVID-19 患者的死亡率。甲基强的松龙的脉冲剂量（OR 0.60，95% CI 0.45-0.80；I2 = 0%）对生存有益。当脉冲甲基强的松龙使用时间少于 7 天时，这一点尤为重要（OR 0.59，95% CI 0.43-0.80；I2 = 0%）。结论 该荟萃分析表明，使用皮质类固醇可能会略微降低 COVID-19 死亡率。然而，它可以显着降低 COVID-19 患者的 MV 需求并限制严重的不良事件。此外，少于 7 天的甲基强的松龙脉冲剂量可能是 COVID-19 患者的良好治疗选择。