Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis.

Adrenal Cortex Hormones / therapeutic use Adult COVID-19 Humans Respiration, Artificial Respiratory Distress Syndrome / drug therapy SARS-CoV-2
ARDS COVID-19 Corticosteroids Mechanical ventilation

Journal

Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851

Informations de publication

Date de publication:
05 2021
Historique:
received: 03 02 2021
accepted: 25 03 2021
pubmed: 21 4 2021
medline: 28 5 2021
entrez: 20 4 2021
Statut: ppublish

Résumé

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. 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. 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. 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.

Identifiants

DOI: 10.1007/s00134-021-06394-2 PMID: 33876268 PMC: PMC8054852
pubmed: 33876268
doi: 10.1007/s00134-021-06394-2
pii: 10.1007/s00134-021-06394-2
pmc: PMC8054852
doi:

Substances chimiques

Adrenal Cortex Hormones 0

Types de publication

Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

521-537

Subventions

Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States

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Auteurs

Dipayan Chaudhuri (D)

Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
ORCID: 0000-0002-8305-1481

Kiyoka Sasaki (K)

Department of Medicine, McMaster University, Hamilton, ON, Canada.

Aram Karkar (A)

Department of Medicine, McMaster University, Hamilton, ON, Canada.

Sameer Sharif (S)

Department of Medicine, McMaster University, Hamilton, ON, Canada.

Kimberly Lewis (K)

Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

Manoj J Mammen (MJ)

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biological Sciences, State University of New York at Buffalo, Buffalo, NY, USA.

Paul Alexander (P)

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

Zhikang Ye (Z)

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

Luis Enrique Colunga Lozano (LEC)

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

Marie Warrer Munch (MW)

Dept. of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Anders Perner (A)

Dept. of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Bin Du (B)

Medical ICU, Peking Union Medical College Hospital, Beijing, China.

Lawrence Mbuagbaw (L)

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Biostatistics Unit, The Research Institute, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

Waleed Alhazzani (W)

Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

Stephen M Pastores (SM)

Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

John Marshall (J)

Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.

François Lamontagne (F)

Department of Medicine and Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.

Djillali Annane (D)

FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), RHU RECORDS (Rapid rEcognition of CORticosteroiD resistant or sensitive Sepsis), Department of Intensive Care, Laboratory of Infection & Inflammation - U1173, School of Medicine Simone Veil, Hôpital Raymond Poincaré (APHP), University Versailles Saint Quentin - University Paris Saclay, INSERM, Garches, France.

Gianfranco Umberto Meduri (GU)

Memphis Veterans Affairs Medical Center Research Service and Pulmonary, Critical Care, and Sleep Medicine Service, Memphis, TN, USA.

Bram Rochwerg (B)

Department of Medicine, McMaster University, Hamilton, ON, Canada. rochwerg@mcmaster.ca.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. rochwerg@mcmaster.ca.
Department of Medicine, Division of Critical Care, Juravinski Hospital, 711 Concession St, Hamilton, ON, L8V 1C1, Canada. rochwerg@mcmaster.ca.

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Classifications MeSH

questionsmedicales.fr › Hormones corticosurrénaliennes › Corticosteroids in COVID-19 and non-COVID-19...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Corticosteroids in COVID-19 and non-COVID-19...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › COVID-19 › Corticosteroids in COVID-19 and non-COVID-19...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Corticosteroids in COVID-19 and non-COVID-19...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Corticosteroids in COVID-19 and non-COVID-19...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Troubles respiratoires › Syndrome de détresse respiratoire de l'adulte › Corticosteroids in COVID-19 and non-COVID-19...
questionsmedicales.fr › Virus › Virus à ARN › Virus à ARN à brin positif › Nidovirales › Coronaviridae › Coronavirus › Betacoronavirus › Virus du SRAS › SARS-CoV-2 › Corticosteroids in COVID-19 and non-COVID-19...