Effect of Corticosteroids therapy on mortality in the COVID-19 patients-
A systematic review and Meta-analysis
Abstract
Background and Purpose: Corticosteroid therapy is still controversial to
use for treatment of coronavirus disease-2019 (COVID-19). The results of
multiple randomized clinical trials (RCTs) and observational studies are
very diverse and contradictory, which arising difficulty in the clinical
decision-making. The objective of this study is to investigate the
effect of corticosteroids on mortality by systematic review and
meta-analysis. External Approach: A systematic search was performed on
different databases namely Medline/PubMed, Cochrane and Google scholar
on 10 February 2022, according to PRISMA guidelines. The 28-days
mortality was considered as outcome of study. A pooled estimate was
calculated with random effects and fixed effects models. Cochran’s Q
test and the I2 statistic were conducted for statistical heterogeneity.
Key Results: 38 studies were included, having sample size of 87,781
patients. Amongst them, 16437 patients received corticosteroid therapy
(intervention group) while 71344 patients were standard
(noncorticosteroids) therapy (control group). 12.68% (2084) mortality
observed in the intervention group while 5.93% (4227) mortality
observed in the control group. The overall pooled estimate showed a
significantly (OR2.305;95%CI: 2.1810 to 2.4370) increased mortality in
intervention group. A pooled fold change estimation showed significantly
increased in the mortality in methylprednisolone (OR 1.206;95%CI:
1.0770 to 1.3500) and dexamethasone (OR 1.388;95% CI:1.1870 to 1.6220)
therapy. Conclusion and Implication: In conclusion, corticosteroid
therapy produced a negative prognosis as depicted by increased mortality
among COVID-19 patients. The possible reasons might be delay in virus
clearance and secondary infection due to initiation of the
corticosteroids at high dose in the early stage of infection.