key: cord-351028-p5cq2is5 authors: Yang, Jia-Wei; Yang, Ling; Luo, Rong-Guang; Xu, Jin-Fu title: Corticosteroid administration for viral pneumonia: COVID-19 and beyond date: 2020-06-27 journal: Clin Microbiol Infect DOI: 10.1016/j.cmi.2020.06.020 sha: doc_id: 351028 cord_uid: p5cq2is5 BACKGROUND: Corticosteroids are commonly used as adjuvant therapy for acute respiratory distress syndrome (ARDS) by many clinicians due to their perceived anti-inflammatory effects. However, for patients with severe viral pneumonia, the corticosteroid treatment is highly controversial. OBJECTIVES: The purpose of this review is to systematically evaluate the effect and potential mechanism of corticosteroid administration in pandemic viral pneumonia. SOURCES: We comprehensively searched all manuscripts on corticosteroids therapy for influenza, SARS, MERS and SARS-CoV-2 viral pneumonia from the PubMed, EMBASE, Web of Science and Cochrane Library databases. CONTENT: We systematic summarized the effects of corticosteroids therapy for pandemic viral pneumonia and the potential mechanism of corticosteroid worked in COVID-19. IMPLICATIONS: Observational studies showed that corticosteroid treatment was associated with increased mortality and nosocomial infections for influenza and delay virus clearance for SARS-CoV and MERS-CoV. Limited data on corticosteroid therapy for COVID-19 were reported. Corticosteroids were used in about a fifth of patients (670/2995, 22.4%). Although clinical observational studies reported the improvement in symptoms and oxygenation for the severe COVID-19 patients received corticosteroids therapy, case fatality rate in the corticosteroid group was significantly higher than that in the non-corticosteroid group (69/443, 15.6% vs 56/1310, 4.3%). Compared with non-severe patients, severe patients were more likely to receive corticosteroid therapy (201/382, 52.6% vs 201/1310, 15.3%). Although there is no evidence of corticosteroid therapy reduce the mortality of COVID-19 patients, some improvements in clinical symptoms and oxygenation were reported in some clinical observational studies. Excessive inflammatory response and lymphopenia might be critical factors associated with disease severity and mortality of COVID-19. Sufficiently powered randomized controlled trials with rigorous inclusion/exclusion criteria and standardized dose and duration of corticosteroids are needed to verify the effectiveness and safety of corticosteroid therapy. Background Corticosteroids are commonly used as adjuvant therapy for acute 23 respiratory distress syndrome (ARDS) by many clinicians due to their perceived 24 anti-inflammatory effects. However, for patients with severe viral pneumonia, the 25 corticosteroid treatment is highly controversial. coronavirus" or "2019-nCoV" or "COVID-19". No language restrictions were set. 106 The references of involved studies were also searched. 107 Two investigators independently extracted useful information and data from original 108 studies. Disagreements were resolved by discussion and consulting statistician. Due to 109 data processing and conversion analysis, some of the results may differ slightly from 110 those published original articles. 111 The initial search identified 19227 potential studies. 18445 articles were excluded by 112 screening of the titles and abstracts due to irrelevance or redundancy. Ultimately, 782 113 full-text articles were reviewed, 212 of which were related to corticosteroid about 114 influenza, 196 were related to corticosteroid about SARS, 33 were related to 115 corticosteroid about MERS, and 341 were related to corticosteroid about COVID-19. 116 The details of the screening process are shown in Figure 1 . that methylprednisolone was the most frequently used corticosteroid. The median 128 daily dose was equivalent to 80 mg of methylprednisolone (Interquartile range: IQR 129 60-120) for a median duration of 7 days (IQR 5-10). After propensity score matching, 130 corticosteroid application for influenza pneumonia was associated with ICU mortality 131 in Cox regression analysis (HR 1.32, 95% CI 1.08-1.60) and competing risks analysis 132 (SHR 1.37, 95% CI 1.12-1.68) in this study [15] . Moreover, studies from (Table S1 ). They showed that corticosteroid therapy was 139 significantly associated with mortality ( Figure 2a The outcomes of corticosteroid therapy in SARS were divergent based on the 166 published researches. We cannot conclude a definite conclusion. 167 Reports on corticosteroids administration for MERS were relatively rare. 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