Efficacy and Safety of Glucocorticoid in the Treatment of Acute Respiratory Distress Syndrome caused by Covid-19: A Systematic Review and Meta-Analysis.

IF 1.2 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
Xiangyang Jiang, Changyun Zhao, Weihang Hu, Difan Lu, Changqin Chen, Shijin Gong, Jing Yan, Wenchao Mao
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引用次数: 0

Abstract

Background: Glucocorticoids are often used to treat acute respiratory distress syndrome (ARDS) and novel coronavirus disease 2019 (COVID-19). However, the efficacy and safety of glucocorticoids in the treatment of ARDS caused by COVID-19 are still controversial; therefore, we conducted this meta-analysis of the literature on this topic.

Methods: Four databases (PubMed, EMBASE, Cochrane Library, and Web of Science) were searched from the establishment of the databases to August 16, 2023. Randomized controlled trials (RCTs) and cohort studies that compared glucocorticoid versus standard treatment for ARDS caused by COVID-19 were included. The Newcastle-Ottawa Scale (NOS) checklist and the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the risk of bias. Review Manager 5.4 software and STATA 17.0 were used for meta-analy-sis, and the relative risk (RR), mean difference, and 95% confidence intervals (CIs) were then determined. Results: A total of 17 studies involving 8592 patients were evaluated, including 14 retrospective studies and 3 RCTs. Sixteen studies reported data on all-cause mortality. The results of the meta-analysis showed that glucocorticoids did not reduce all-cause (RR, 0.96; 95% CI 0.82-1.13, P = .62) or 28-day (RR, 1.01; 95% CI 0.78-1.32, P = .93) mortality. Subgroup analysis showed that only methylprednisolone reduced all-cause mortality. No matter whether glucocorticoid use was early or delayed, high-dose or low-dose, long-term or short-term, no regimen reduced all-cause mortality. Furthermore, there were no significant differences in length of intensive care unit (ICU) stay, length of hospital stay, hyperglycemia, and ventilator-associated pneumonia (VAP); how-ever, glucocorticoids increased the number of ventilator-free days.

Conclusions: Although methylprednisolone may reduce all-cause mortality from ARDS caused by COVID-19, this effect was not found with other types of glucocorticoids. At the same time, glucocorticoid use was associ-ated with more ventilator-free days, without increasing the incidence of hyperglycemic events or VAP. Con-sidering that almost all of the included studies were retrospective cohort studies, more RCTs are needed to confirm these findings.

糖皮质激素治疗由 Covid-19 引起的急性呼吸窘迫综合征的有效性和安全性:系统回顾与元分析》。
背景:糖皮质激素常用于治疗急性呼吸窘迫综合征(ARDS)和新型冠状病毒病2019(COVID-19)。然而,糖皮质激素治疗COVID-19引起的ARDS的有效性和安全性仍存在争议;因此,我们对这一主题的文献进行了荟萃分析:方法:检索了自数据库建立至 2023 年 8 月 16 日的四个数据库(PubMed、EMBASE、Cochrane Library 和 Web of Science)。纳入了对COVID-19引起的ARDS进行糖皮质激素与标准治疗比较的随机对照试验(RCT)和队列研究。采用纽卡斯尔-渥太华量表(NOS)核对表和《科克伦干预措施系统综述手册》评估偏倚风险。使用 Review Manager 5.4 软件和 STATA 17.0 进行元分析,然后确定相对风险 (RR)、平均差异和 95% 置信区间 (CI)。结果共评估了 17 项研究,涉及 8592 名患者,其中包括 14 项回顾性研究和 3 项研究性临床试验。16项研究报告了全因死亡率数据。荟萃分析结果显示,糖皮质激素不能降低全因死亡率(RR,0.96;95% CI 0.82-1.13,P = .62)或 28 天死亡率(RR,1.01;95% CI 0.78-1.32,P = .93)。亚组分析显示,只有甲基强的松龙能降低全因死亡率。无论糖皮质激素的使用是早期还是延迟、大剂量还是小剂量、长期还是短期,任何方案都不能降低全因死亡率。此外,在重症监护室(ICU)停留时间、住院时间、高血糖和呼吸机相关肺炎(VAP)方面没有明显差异;但糖皮质激素增加了无呼吸机天数:结论:尽管甲基强的松龙可降低 COVID-19 引起的 ARDS 的全因死亡率,但其他类型的糖皮质激素却没有这种效果。同时,使用糖皮质激素可增加无呼吸机天数,但不会增加高血糖事件或 VAP 的发生率。考虑到几乎所有纳入的研究都是回顾性队列研究,因此需要更多的研究性试验来证实这些发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical and Investigative Medicine
Clinical and Investigative Medicine 医学-医学:研究与实验
CiteScore
1.50
自引率
12.50%
发文量
18
审稿时长
>12 weeks
期刊介绍: Clinical and Investigative Medicine (CIM), publishes original work in the field of Clinical Investigation. Original work includes clinical or laboratory investigations and clinical reports. Reviews include information for Continuing Medical Education (CME), narrative review articles, systematic reviews, and meta-analyses.
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