Systemic administration of glucocorticoids, cardiovascular complications and mortality in patients hospitalised with COVID-19, SARS, MERS or influenza: A systematic review and meta-analysis of randomised trials.
COVID-19
/ mortality
Cardiovascular Diseases
/ etiology
Coronavirus Infections
/ drug therapy
Glucocorticoids
/ therapeutic use
Hospitalization
Humans
Influenza, Human
/ drug therapy
Randomized Controlled Trials as Topic
SARS-CoV-2
/ drug effects
Severe Acute Respiratory Syndrome
/ drug therapy
COVID-19 Drug Treatment
COVID-19
Dexamethasone
Glucocorticoids
Meta-analysis
Mortality
Steroids
Journal
Pharmacological research
ISSN: 1096-1186
Titre abrégé: Pharmacol Res
Pays: Netherlands
ID NLM: 8907422
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
02
12
2021
revised:
28
12
2021
accepted:
29
12
2021
pubmed:
4
1
2022
medline:
19
2
2022
entrez:
3
1
2022
Statut:
ppublish
Résumé
Administration of glucocorticoids might reduce mortality in patients with severe COVID-19 but have adverse cardiometabolic effects. to investigate the effect of systemic administration of glucocorticoids on cardiovascular complications and all-cause mortality in patients hospitalised with respiratory viral infections, including COVID-19, SARS, MERS and influenza. We identified randomised trials published prior to July 28th, 2021. The Mantel-Haenszel random effects method and the Hartung and Knapp adjustment were used to obtain pooled estimates of treatment effect with 95% confidence intervals. No randomised trials of glucocorticoids for SARS, MERS or influenza reported relevant outcomes. We included eleven COVID-19 randomised trials (8109 patients). Overall, compared to placebo or standard care, glucocorticoids were not associated with a reduction of in-hospital mortality (p = 0.09). In a pre-specified sub-analysis, in-hospital mortality was reduced by 19% when follow-up was restricted to 14 days from randomisation (5/11 trials, 1329 patients, p = 0.02). With longer follow-up (9/11 trials, 7874 patients), administration of glucocorticoids was associated with a trend to benefit for those requiring mechanical ventilation (RR 0.86; 95% CI 0.57-1.27) but possible harm for those not receiving oxygen at randomisation (RR 1.27; 95% CI 1.00 - 1.61), an effect that was significantly different amongst subgroups (p = 0.0359). Glucocorticoids reduced the risk of worsening renal function by 37% (4/11 trials); reported rate of other cardiovascular complications was low. Administration of systemic glucocorticoids to patients hospitalised with COVID-19 does not lower mortality overall but may reduce it in those requiring respiratory support and increase it in those who do not.
Sections du résumé
BACKGROUND
Administration of glucocorticoids might reduce mortality in patients with severe COVID-19 but have adverse cardiometabolic effects.
OBJECTIVES
to investigate the effect of systemic administration of glucocorticoids on cardiovascular complications and all-cause mortality in patients hospitalised with respiratory viral infections, including COVID-19, SARS, MERS and influenza.
METHODS
We identified randomised trials published prior to July 28th, 2021. The Mantel-Haenszel random effects method and the Hartung and Knapp adjustment were used to obtain pooled estimates of treatment effect with 95% confidence intervals.
RESULTS
No randomised trials of glucocorticoids for SARS, MERS or influenza reported relevant outcomes. We included eleven COVID-19 randomised trials (8109 patients). Overall, compared to placebo or standard care, glucocorticoids were not associated with a reduction of in-hospital mortality (p = 0.09). In a pre-specified sub-analysis, in-hospital mortality was reduced by 19% when follow-up was restricted to 14 days from randomisation (5/11 trials, 1329 patients, p = 0.02). With longer follow-up (9/11 trials, 7874 patients), administration of glucocorticoids was associated with a trend to benefit for those requiring mechanical ventilation (RR 0.86; 95% CI 0.57-1.27) but possible harm for those not receiving oxygen at randomisation (RR 1.27; 95% CI 1.00 - 1.61), an effect that was significantly different amongst subgroups (p = 0.0359). Glucocorticoids reduced the risk of worsening renal function by 37% (4/11 trials); reported rate of other cardiovascular complications was low.
CONCLUSIONS
Administration of systemic glucocorticoids to patients hospitalised with COVID-19 does not lower mortality overall but may reduce it in those requiring respiratory support and increase it in those who do not.
Identifiants
pubmed: 34979235
pii: S1043-6618(21)00637-X
doi: 10.1016/j.phrs.2021.106053
pmc: PMC8719379
pii:
doi:
Substances chimiques
Glucocorticoids
0
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
106053Subventions
Organisme : British Heart Foundation
ID : PG/19/84/34771
Pays : United Kingdom
Organisme : British Heart Foundation
ID : PG/21/10541
Pays : United Kingdom
Organisme : British Heart Foundation
ID : PG/21/10634
Pays : United Kingdom
Organisme : European Research Council
Pays : International
Informations de copyright
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
Références
N Engl J Med. 2021 Feb 25;384(8):693-704
pubmed: 32678530
Lancet. 2021 Sep 4;398(10303):843-855
pubmed: 34388395
Anesth Prog. 2013 Spring;60(1):25-31; quiz 32
pubmed: 23506281
Ann Intern Med. 2004 Nov 16;141(10):764-70
pubmed: 15545676
Acta Anaesthesiol Scand. 2021 Nov;65(10):1421-1430
pubmed: 34138478
Eur Respir J. 2016 Oct;48(4):1150-1159
pubmed: 27471201
J Infect Public Health. 2020 Nov;13(11):1652-1663
pubmed: 33008778
Cochrane Database Syst Rev. 2019 Feb 24;2:CD010406
pubmed: 30798570
Crit Care. 2020 Dec 14;24(1):696
pubmed: 33317589
J Infect Dis. 2015 Jul 15;212(2):183-94
pubmed: 25406333
CMAJ. 2020 Jul 6;192(27):E756-E767
pubmed: 32409522
J Clin Virol. 2004 Dec;31(4):304-9
pubmed: 15494274
Lancet. 2015 Apr 18;385(9977):1511-8
pubmed: 25608756
Respiration. 2021;100(2):116-126
pubmed: 33486496
Medicine (Baltimore). 2021 May 21;100(20):e25719
pubmed: 34011029
Infect Dis Ther. 2021 Dec;10(4):2447-2463
pubmed: 34389970
Am J Respir Crit Care Med. 2021 Jan 15;203(2):192-201
pubmed: 33217246
Lancet Respir Med. 2021 Jul;9(7):763-772
pubmed: 33844996
PLoS Med. 2006 Sep;3(9):e343
pubmed: 16968120
Indian J Pharmacol. 2020 Nov-Dec;52(6):535-550
pubmed: 33666200
PLoS Med. 2020 Dec 3;17(12):e1003432
pubmed: 33270649
PLoS One. 2021 Apr 21;16(4):e0249481
pubmed: 33882090
Chest. 2021 Mar;159(3):1019-1040
pubmed: 33129791
J Med Virol. 2021 Mar;93(3):1538-1547
pubmed: 32881007
JAMA. 2020 Oct 6;324(13):1307-1316
pubmed: 32876695
Signal Transduct Target Ther. 2021 Feb 21;6(1):83
pubmed: 33612824
PLoS One. 2012;7(2):e32280
pubmed: 22393395
JAMA. 2020 Oct 6;324(13):1317-1329
pubmed: 32876697
JAMA. 2020 Oct 6;324(13):1330-1341
pubmed: 32876694
Sci Rep. 2021 Apr 23;11(1):8816
pubmed: 33893337
Intensive Care Med. 2021 May;47(5):521-537
pubmed: 33876268
Expert Rev Respir Med. 2021 Aug;15(8):1049-1055
pubmed: 33945381
Sci Rep. 2020 Feb 20;10(1):3044
pubmed: 32080223
Lancet. 2021 Jul 17;398(10296):223-237
pubmed: 34274064
BMC Infect Dis. 2021 Apr 10;21(1):337
pubmed: 33838657
JAMA. 2021 Nov 9;326(18):1807-1817
pubmed: 34673895
Crit Care. 2019 Mar 27;23(1):99
pubmed: 30917856
Iran J Public Health. 2020 Aug;49(8):1411-1421
pubmed: 33083317
CMAJ. 2020 Mar 23;192(12):E295-E301
pubmed: 32392512
Res Synth Methods. 2019 Dec;10(4):515-527
pubmed: 31111673
Ann Transl Med. 2020 May;8(10):627
pubmed: 32566564
Cochrane Database Syst Rev. 2016 Mar 07;3:CD010406
pubmed: 26950335
Eur J Pharmacol. 2021 Apr 15;897:173947
pubmed: 33607104
Shock. 2021 Aug 1;56(2):215-228
pubmed: 33555845
Interdiscip Perspect Infect Dis. 2021 May 6;2021:6650469
pubmed: 34035806
Trials. 2020 Aug 16;21(1):717
pubmed: 32799933
Lancet. 2020 Feb 15;395(10223):473-475
pubmed: 32043983
Heart. 2004 Aug;90(8):859-65
pubmed: 15253953
Clin Infect Dis. 2021 May 4;72(9):e373-e381
pubmed: 32785710
Eur Respir J. 2020 Dec 24;56(6):
pubmed: 32943404
J Cardiothorac Vasc Anesth. 2021 Feb;35(2):578-584
pubmed: 33298370
JAMA. 2020 Oct 6;324(13):1298-1306
pubmed: 32876689
Am J Respir Crit Care Med. 2018 Mar 15;197(6):757-767
pubmed: 29161116
Wien Klin Wochenschr. 2021 Apr;133(7-8):303-311
pubmed: 33534047
J Clin Epidemiol. 2009 Oct;62(10):1006-12
pubmed: 19631508
Nat Rev Cardiol. 2020 Sep;17(9):543-558
pubmed: 32690910
Cochrane Database Syst Rev. 2021 Mar 11;3:CD013879
pubmed: 33704775
Leukemia. 2020 Jun;34(6):1503-1511
pubmed: 32372026