Effects of corticosteroids on Covid-19 patients: A systematic review and meta-analysis on clinical outcomes

Background: Covid-19 disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although corticosteroids have shown some promising results in Covid-19 patients, their effectiveness remains controversial. In this systematic review, we evaluated the effect of corticosteroids in mortality, Hospitalization, ICU admission, intubation, and mechanical ventilation in Covid-19 patients. Methods: We searched major databases from March-2020 to Jan-2021. Twenty-nine studies were included after evaluating the eligibility of the literature. The extracted data for mortality, hospitalization, admission to the ICU, intubation, and mechanical ventilation were analyzed with RevMan® 5.4. Categorical variables are presented with odds ratios (OR), and numerical variables are shown with the mean difference. Result: Corticosteroid treatment had no impact on mortality in 18,190 covid patients with OR = 1.12[0.83–1.50]. When we include the randomized controlled trials, corticosteroids reduced the mortality by 20% (OR = 0.80 [0.73, 0.88]; P < 0.001). Additionally, the risk of admission to the ICU, the need for endotracheal intubation, and mechanical ventilation were comparable between patients receiving corticosteroids and controls. The duration of hospitalization was also similar in the two groups. Conclusion: Corticosteroid therapy may not be effective for reducing mortality, length of hospitalization, the likelihood of intubation and mechanical ventilation, and ICU admission in patients suffering from Covid-19 pneumonia.