Association between glucocorticoids treatment and viral clearance delay in patients with COVID-19: a systematic review and meta-analysis
Open Access
- 14 October 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 21 (1), 1-13
- https://doi.org/10.1186/s12879-021-06548-z
Abstract
Evidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear. In this systematic review and meta-analysis, we searched for studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, and ClinicalTrials.gov from 2019 to April 20, 2021. We mainly pooled the risk ratios (RRs) and mean difference (MD) for viral clearance delay and did subgroup analyses by the severity of illness and doses of glucocorticoids. 38 studies with a total of 9572 patients were identified. Glucocorticoids treatment was associated with delayed viral clearance in COVID-19 patients (adjusted RR 1.52, 95% CI 1.29 to 1.80, I2 = 52%), based on moderate-quality evidence. In subgroup analyses, risk of viral clearance delay was significant both for COVID-19 patients being mild or moderate ill (adjusted RR 1.86, 95% CI 1.35 to 2.57, I2 = 48%), and for patients of being severe or critical ill (adjusted RR 1.59, 95% CI 1.23 to 2.07, I2 = 0%); however, this risk significantly increased for patients taking high doses (unadjusted RR 1.85, 95% CI 1.08 to 3.18; MD 7.19, 95% CI 2.78 to 11.61) or medium doses (adjusted RR 1.86, 95% CI 0.96 to 3.62, I2 = 45%; MD 3.98, 95% CI 3.07 to 4.88, I2 = 4%), rather those taking low doses (adjusted RR 1.38, 95% CI 0.94 to 2.02, I2 = 59%; MD 1.46, 95% CI −0.79 to 3.70, I2 = 82%). Glucocorticoids treatment delayed viral clearance in COVID-19 patients of taking high doses or medium doses, rather in those of taking low doses of glucocorticoids.Funding Information
- the Project of Novel Coronavirus Pneumonia in West China Hospital (HX2019nCoV027)
- Sichuan Science and Technology Programs (2021YFS0003, 2021YJ0448)
This publication has 60 references indexed in Scilit:
- Plea for routinely presenting prediction intervals in meta-analysisBMJ Open, 2016
- Adjuvant Corticosteroid Treatment in Adults With Influenza A (H7N9) Viral Pneumonia*Critical Care Medicine, 2016
- Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 daysInfluenza and Other Respiratory Viruses, 2012
- Dexamethasone Treatment Has No Effect on the Formation of Pneumococcal Antibodies during Community-Acquired PneumoniaClinical and Vaccine Immunology, 2012
- Outlier and influence diagnostics for meta-analysisResearch Synthesis Methods, 2010
- Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patientsJournal of Clinical Virology, 2004
- Hazard Ratio in Clinical TrialsAntimicrobial Agents and Chemotherapy, 2004
- Meta-analysis of Observational Studies in EpidemiologyA Proposal for ReportingJAMA, 2000
- What's the Relative Risk?JAMA, 1998
- Effects of Corticosteroids on Immunity in Man I. DECREASED SERUM IgG CONCENTRATION CAUSED BY 3 OR 5 DAYS OF HIGH DOSES OF METHYLPREDNISOLONEJCI Insight, 1973