TY - JOUR
T1 - Corticosteroids in COVID-19 and non-COVID-19 ARDS
T2 - a systematic review and meta-analysis
AU - Chaudhuri, Dipayan
AU - Sasaki, Kiyoka
AU - Karkar, Aram
AU - Sharif, Sameer
AU - Lewis, Kimberly
AU - Mammen, Manoj J.
AU - Alexander, Paul
AU - Ye, Zhikang
AU - Lozano, Luis Enrique Colunga
AU - Munch, Marie Warrer
AU - Perner, Anders
AU - Du, Bin
AU - Mbuagbaw, Lawrence
AU - Alhazzani, Waleed
AU - Pastores, Stephen M.
AU - Marshall, John
AU - Lamontagne, François
AU - Annane, Djillali
AU - Meduri, Gianfranco Umberto
AU - Rochwerg, Bram
N1 - Publisher Copyright:
© 2021, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/5
Y1 - 2021/5
N2 - Purpose: Corticosteroids are now recommended for patients with severe COVID-19 including those with COVID-related ARDS. This has generated renewed interest regarding whether corticosteroids should be used in non-COVID ARDS as well. The objective of this study was to summarize all RCTs examining the use of corticosteroids in ARDS. Methods: The protocol of this study was pre-registered on PROSPERO (CRD42020200659). We searched online databases including MEDLINE, EMBASE, CDC library of COVID research, CINAHL, and COCHRANE. We included RCTs that compared the effect of corticosteroids to placebo or usual care in adult patients with ARDS, including patients with COVID-19. Three reviewers abstracted data independently and in duplicate using a pre-specified standardized form. We assessed individual study risk of bias using the revised Cochrane ROB-2 tool and rated certainty in outcomes using GRADE methodology. We pooled data using a random effects model. The main outcome for this review was 28-day-mortality. Results: We included 18 RCTs enrolling 2826 patients. The use of corticosteroids probably reduced mortality in patients with ARDS of any etiology (2740 patients in 16 trials, RR 0.82, 95% CI 0.72–0.95, ARR 8.0%, 95% CI 2.2–12.5%, moderate certainty). Patients who received a longer course of corticosteroids (over 7 days) had higher rates of survival compared to a shorter course. Conclusion: The use of corticosteroids probably reduces mortality in patients with ARDS. This effect was consistent between patients with COVID-19 and non-COVID-19 ARDS, corticosteroid types, and dosage.
AB - Purpose: Corticosteroids are now recommended for patients with severe COVID-19 including those with COVID-related ARDS. This has generated renewed interest regarding whether corticosteroids should be used in non-COVID ARDS as well. The objective of this study was to summarize all RCTs examining the use of corticosteroids in ARDS. Methods: The protocol of this study was pre-registered on PROSPERO (CRD42020200659). We searched online databases including MEDLINE, EMBASE, CDC library of COVID research, CINAHL, and COCHRANE. We included RCTs that compared the effect of corticosteroids to placebo or usual care in adult patients with ARDS, including patients with COVID-19. Three reviewers abstracted data independently and in duplicate using a pre-specified standardized form. We assessed individual study risk of bias using the revised Cochrane ROB-2 tool and rated certainty in outcomes using GRADE methodology. We pooled data using a random effects model. The main outcome for this review was 28-day-mortality. Results: We included 18 RCTs enrolling 2826 patients. The use of corticosteroids probably reduced mortality in patients with ARDS of any etiology (2740 patients in 16 trials, RR 0.82, 95% CI 0.72–0.95, ARR 8.0%, 95% CI 2.2–12.5%, moderate certainty). Patients who received a longer course of corticosteroids (over 7 days) had higher rates of survival compared to a shorter course. Conclusion: The use of corticosteroids probably reduces mortality in patients with ARDS. This effect was consistent between patients with COVID-19 and non-COVID-19 ARDS, corticosteroid types, and dosage.
KW - ARDS
KW - COVID-19
KW - Corticosteroids
KW - Mechanical ventilation
UR - https://www.scopus.com/pages/publications/85106756654
U2 - 10.1007/s00134-021-06394-2
DO - 10.1007/s00134-021-06394-2
M3 - Review article
C2 - 33876268
AN - SCOPUS:85106756654
SN - 0342-4642
VL - 47
SP - 521
EP - 537
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 5
ER -