Higher versus lower dose corticosteroids for severe to critical COVID-19: A systematic review and dose-response meta-analysis
Abstract Purpose Corticosteroids are standard of care for patients with severe COVID-19. However, the optimal dose is uncertain. We compare higher doses of corticosteroids with lower doses in patients with COVID-19. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, MedRxiv, and Web of Science from inception to January 7, 2022, for trials that randomized patients with severe-to-critical COVID-19 to corticosteroids, standard care, or placebo. Reviewers, working in duplicate, screened references, extracted data, and assessed risk of bias using a modified version of the Cochrane risk of bias 2.0 tool. We performed a dose-response meta-analysis and used the GRADE framework to assess the certainty of evidence. We present our results in absolute risk difference (RD) per 1000 with 95% confidence intervals (CI). Results We included 19 trials, with 9,609 patients. We show that, compared to lower-dose corticosteroids, higher-dose corticosteroids probably reduce mortality (RD 14.8 fewer deaths per 1000 [95% CI 6.0 to 27.9 fewer]; moderate certainty), may reduce the need for mechanical ventilation (RD 10.4 fewer per 1000 [95% CI 19.2 fewer to 3.6 more]; low certainty) and may reduce risk of nosocomial infections (16.7 fewer infections per 1000 [95% CI 5.4 to 25.0 fewer]; low certainty). Conclusions Relatively higher doses of corticosteroids may be beneficial in patients with severe-to-critical COVID-19 without increasing the risk of nosocomial infections..
| Medienart: |
|
|---|
Preprint| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
ResearchSquare.com - (2022) vom: 05. Dez. Zur Gesamtaufnahme - year:2022 |
|---|
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Pitre, Tyler [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| doi: |
10.21203/rs.3.rs-1479424/v1 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
XRA035569603 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | XRA035569603 | ||
| 003 | DE-627 | ||
| 005 | 20230429201635.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 220324s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.21203/rs.3.rs-1479424/v1 |2 doi | |
| 035 | |a (DE-627)XRA035569603 | ||
| 035 | |a (ResearchSquare)10.21203/rs.3.rs-1479424/v1 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Pitre, Tyler |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Higher versus lower dose corticosteroids for severe to critical COVID-19: A systematic review and dose-response meta-analysis |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 520 | |a Abstract Purpose Corticosteroids are standard of care for patients with severe COVID-19. However, the optimal dose is uncertain. We compare higher doses of corticosteroids with lower doses in patients with COVID-19. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, MedRxiv, and Web of Science from inception to January 7, 2022, for trials that randomized patients with severe-to-critical COVID-19 to corticosteroids, standard care, or placebo. Reviewers, working in duplicate, screened references, extracted data, and assessed risk of bias using a modified version of the Cochrane risk of bias 2.0 tool. We performed a dose-response meta-analysis and used the GRADE framework to assess the certainty of evidence. We present our results in absolute risk difference (RD) per 1000 with 95% confidence intervals (CI). Results We included 19 trials, with 9,609 patients. We show that, compared to lower-dose corticosteroids, higher-dose corticosteroids probably reduce mortality (RD 14.8 fewer deaths per 1000 [95% CI 6.0 to 27.9 fewer]; moderate certainty), may reduce the need for mechanical ventilation (RD 10.4 fewer per 1000 [95% CI 19.2 fewer to 3.6 more]; low certainty) and may reduce risk of nosocomial infections (16.7 fewer infections per 1000 [95% CI 5.4 to 25.0 fewer]; low certainty). Conclusions Relatively higher doses of corticosteroids may be beneficial in patients with severe-to-critical COVID-19 without increasing the risk of nosocomial infections. | ||
| 650 | 4 | |a Biology |7 (dpeaa)DE-84 | |
| 650 | 4 | |a 570 |7 (dpeaa)DE-84 | |
| 700 | 1 | |a Su, Johnny |e verfasserin |4 aut | |
| 700 | 1 | |a Mah, Jasmine |e verfasserin |4 aut | |
| 700 | 1 | |a Helmeczi, Wryan |e verfasserin |4 aut | |
| 700 | 1 | |a Danhoe, Sharef |e verfasserin |4 aut | |
| 700 | 1 | |a Plaxton, William |e verfasserin |4 aut | |
| 700 | 1 | |a Giilck, Stephen |e verfasserin |4 aut | |
| 700 | 1 | |a Rochwerg, Bram |e verfasserin |4 aut | |
| 700 | 1 | |a Zeraatkar, Dena |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t ResearchSquare.com |g (2022) vom: 05. Dez. |
| 773 | 1 | 8 | |g year:2022 |g day:05 |g month:12 |
| 856 | 4 | 0 | |u https://doi.org/10.1513/AnnalsATS.202208-720OC |z lizenzpflichtig |3 Volltext |
| 856 | 4 | 0 | |u http://dx.doi.org/10.21203/rs.3.rs-1479424/v1 |z kostenfrei |3 Volltext |
| 912 | |a GBV_XRA | ||
| 912 | |a SSG-OLC-PHA | ||
| 951 | |a AR | ||
| 952 | |j 2022 |b 05 |c 12 | ||