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- Title
Higher versus Lower Dose Corticosteroids for Severe to Critical COVID-19: A Systematic Review and Dose-Response Meta-analysis.
- Authors
Pitre, Tyler; Su, Johnny; Mah, Jasmine; Helmeczi, Wryan; Danho, Sharef; Plaxton, William; Giilck, Stephen; Rochwerg, Bram; Zeraatkar, Dena; Danhoe, Sharef
- Abstract
<bold>Rationale: </bold>Corticosteroids are standard of care for patients with severe COVID-19. However, the optimal dose is uncertain.<bold>Objective: </bold>To compare higher doses of corticosteroids with lower doses in patients with COVID-19.<bold>Methods: </bold>We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, MedRxiv, and Web of Science from inception to August 1st, 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 both in relative risk and absolute risk difference (RD) per 1000 with 95% confidence intervals (CI).<bold>Results: </bold>We included 20 trials, with 10,155 patients. We show that, compared to lower-dose corticosteroids, higher-dose corticosteroids probably reduce mortality (RD 14 fewer deaths per 1000 [95% CI 26 to 2 fewer]; moderate certainty) and may reduce the need for mechanical ventilation (RD 11.6 fewer per 1000 [95% CI 23.2 fewer to 6.9 more]; low certainty). The effect of corticosteroids on nosocomial infections is uncertain (16.7 fewer infections per 1000 [95% CI 5.4 to 25.0 fewer]; very low certainty).<bold>Conclusions: </bold>Relatively higher doses of corticosteroids may be beneficial in patients with severe-to-critical COVID-19 and may not increase the risk of nosocomial infections. .
- Subjects
COVID-19; NOSOCOMIAL infections; SEQUENTIAL analysis; CORTICOSTEROIDS
- Publication
Annals of the American Thoracic Society, 2023, Vol 20, Issue 4, p596
- ISSN
2329-6933
- Publication type
Article
- DOI
10.1513/AnnalsATS.202208-720OC