PMID- 34122093
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210615
IS  - 1663-9812 (Print)
IS  - 1663-9812 (Electronic)
IS  - 1663-9812 (Linking)
VI  - 12
DP  - 2021
TI  - Systemic Corticosteroid Administration in Coronavirus Disease 2019 Outcomes: An 
      Umbrella Meta-Analysis Incorporating Both Mild and Pulmonary Fibrosis-Manifested 
      Severe Disease.
PG  - 670170
LID - 10.3389/fphar.2021.670170 [doi]
LID - 670170
AB  - Background: Effective treatments for coronavirus disease 2019 (COVID-19) are 
      urgently needed. The real role of corticosteroid use in COVID-19 has long been of 
      interest and is disputable. Methods: We aimed to quantitatively reevaluate the 
      efficacy of corticosteroids on COVID-19. Databases were searched for eligible 
      meta-analyses/systematic reviews with available outcome data. For each 
      association, we estimated the summary effect size with fixed- and random-effects 
      models, 95% confidence intervals, and 95% prediction intervals. Heterogeneity, 
      Egger's test, evidence of small-study effects and excess significance bias, and 
      subgroup analyses were rigorously evaluated. Results: Intended outcomes of 12 
      eligible studies were mortality, clinical improvement, hospitalization, 
      mechanical ventilation (MV), adverse events (AEs), intensive care unit (ICU) 
      stay, hospital stay, virus clearance time (VCT), and negative conversion. 
      Corticosteroid administration was associated with a 27% risk reduction in MV 
      [hazard ratio (HR): 0.73 (0.64-0.83)] and a 20% reduction in mortality of 
      critically ill/severe COVID-19 patients [HR: 0.80 (0.65-0.98)]. Interestingly, 
      shorter ICU stays and, conversely, potentially longer hospital stays, a longer 
      VCT, and a longer time to negative conversion were associated with corticosteroid 
      use. There was no significant impact of different corticosteroid doses on 
      mortality. Only one study showed slightly excess significant bias. Caution should 
      be applied given the weak nature of the evidence, and it has been confirmed by 
      sensitivity analyses too. Conclusion: This umbrella study found benefits from 
      corticosteroids on MV and especially the mortality of critically ill/severe 
      patients with shorter ICU stays but prolonged hospital stays and VCT. The 
      benefits and harms should be reevaluated and balanced before corticosteroids are 
      cautiously prescribed in clinical practice.
CI  - Copyright (c) 2021 Cheng, Ma, Yang, Shao, Zhao and Zeng.
FAU - Cheng, Bin
AU  - Cheng B
AD  - Department of Emergency and Critical Care Medicine, The Second Affiliated 
      Hospital of Nanchang University, Nanchang, China.
FAU - Ma, Jinxiu
AU  - Ma J
AD  - Department of Respiratory and Critical Care Medicine, The Second Affiliated 
      Hospital of Nanchang University, Nanchang, China.
FAU - Yang, Yani
AU  - Yang Y
AD  - Department of Respiratory and Critical Care Medicine, The Second Affiliated 
      Hospital of Nanchang University, Nanchang, China.
FAU - Shao, Tingting
AU  - Shao T
AD  - Department of Respiratory and Critical Care Medicine, The Second Affiliated 
      Hospital of Nanchang University, Nanchang, China.
FAU - Zhao, Binghao
AU  - Zhao B
AD  - Department of Neurosurgery, Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
FAU - Zeng, Linxiang
AU  - Zeng L
AD  - Department of Respiratory and Critical Care Medicine, The Second Affiliated 
      Hospital of Nanchang University, Nanchang, China.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210526
PL  - Switzerland
TA  - Front Pharmacol
JT  - Frontiers in pharmacology
JID - 101548923
PMC - PMC8187793
OTO - NOTNLM
OT  - COVID-19
OT  - coronavirus
OT  - corticosteroids
OT  - critically ill/pulmonary fibrosis manifested
OT  - umbrella meta-analysis
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/06/15 06:00
MHDA- 2021/06/15 06:01
PMCR- 2021/05/26
CRDT- 2021/06/14 09:35
PHST- 2021/02/24 00:00 [received]
PHST- 2021/04/30 00:00 [accepted]
PHST- 2021/06/14 09:35 [entrez]
PHST- 2021/06/15 06:00 [pubmed]
PHST- 2021/06/15 06:01 [medline]
PHST- 2021/05/26 00:00 [pmc-release]
AID - 670170 [pii]
AID - 10.3389/fphar.2021.670170 [doi]
PST - epublish
SO  - Front Pharmacol. 2021 May 26;12:670170. doi: 10.3389/fphar.2021.670170. 
      eCollection 2021.