key: cord-0902750-vfy0d3sk authors: Jia, Xinyu; Zhang, Hengrui; Ma, Yuan; Wu, Zhenzhen; Ji, Ningfei; Huang, Mao title: The prognosis and short-term efficacy of corticosteroid therapy for COVID-19 patients date: 2020-08-21 journal: J Biomed Res DOI: 10.7555/jbr.34.20200079 sha: 6f735f686a1646ddf6f109d3121d8fd410960039 doc_id: 902750 cord_uid: vfy0d3sk nan further analyzed the oxygen and blood indexes of 12 patients with complete data (≥4 consultations, followup time ≥10 days). The average course of corticosteroid treatment was 8 days. It was determined that short-term treatment with corticosteroids improved oxygen saturation (SaO 2 ) and the ratio of arterial oxygen tension (PaO 2 ) to inspiratory oxygen fraction (FiO 2 ), and promoted the absorption of pulmonary lesions ( Table 2 ). All statistical analyses were conducted by SPSS software (version 13.0). The results indicated that corticosteroids played a positive role in improving the short-term oxygenation of COVID-19 patients. To include more cases to test the hypothesis, we decided to carry out a meta-analysis. We carried out a systematic literature search on the PubMed, EMBASE, and Web of Science databases for relevant studies on COVID-19. We used the following keywords in our search: "2019-nCoV", "COVID-19", and "SARS-CoV-2". To avoid literature omission, we did not use "corticosteroids" or other keywords related to treatment. Articles dated up to March 15, 2020 were searched without language limit. Inclusion criteria were as follows: (1) the definite diagnosis of COVID-19; (2) two groups of corticosteroid use and non-corticosteroid use; (3) the clinical data available to extract. Exclusion criteria were as follows: (1) repeated publication; (2) failure to get the full text or detailed abstract; (3) the articles of editorials, reviews, or expert consensus; (4) difficulty in extracting the necessary data. Two researchers independently selected articles and extracted the data by reading the titles, abstracts, and full texts of the articles. The binary data analysis was conducted by Stata software (version 14.1). A total of 2431 articles were preliminarily retrieved. After deduplication and assessment of titles, abstracts, and full texts, six articles were chosen for study [7] [8] [9] [10] [11] [12] (Fig. 1) . We used the Newcastle-Ottawa scale to evaluate the quality of the study [13] (Table 3) . We also included our research data, in which 38 patients used corticosteroids including 32 patients with severe conditions. The conditions of 18 users were improved or stable, while 16 of the non-users achieved the same result. The conditions of the remaining patients were aggravated or even deteriorated. Characteristics of studies included are shown in Table 3 . Finally, a total of 1625 subjects, including 441 corticosteroid users and 1184 non-users, were included from these 7 articles. The forest plot of critical and non-critical patients ( Fig. 2A) showed critical patients are more likely to use corticosteroids (OR, 4.82; 95% CI, ). The result of corticosteroid use ( Fig. 2B and C) showed the improvement rate of the corticosteroid group was lower than that of Due to the small number of articles, we did not conduct heterogeneity analysis. Some related meta-analyses of corticosteroid therapy for lung diseases used mortality, need for intensive care unit (ICU) admission or mechanical ventilation as prognostic indicators. In this metaanalysis, we selected only mortality. Because we thought the need for ICU or mechanical ventilation was the evaluation criteria for critical patients who need to use corticosteroids according to the experts consensus. It could not be used as a prognostic indicator simply. However, although the composite endpoints included admission to the ICU, mechanical ventilation, or death, a study by Weijie G et al [11] was included after discussion due to the large number of subjects and extra subgroups of non-severe and severe patients. Currently, evidence for the use of corticosteroid therapy for COVID-19 patients is mostly empirical. This meta-analysis provided the first preliminary systematic review showing the prognosis and shortterm efficacy of corticosteroid use for COVID-19. Obviously, our analysis has some limitations. First, the effect of mechanical ventilation on patients' oxygenation status was not considered. Moreover, due to the limited data, the changes of indicators in the noncorticosteroid group were not discussed. Second, the studies included in the meta-analysis were mostly retrospective studies rather than high-quality randomized controlled trial (RCT) studies. Third, due to the small number of included articles, we included two that used discharge as an evaluation of improvement/stabilization, which was not consistent with other included studies. Fourth, the included studies were all Chinese studies. More studies from other different countries and regions need to be considered to carry out RCT studies and subgroup analysis. We believed, based on the front-line COVID-19 treatment experience, that the use of corticosteroids might have a positive effect on improving the shortterm oxygenation of critically ill patients. However, there is no evidence-based support for this claim. Some researchers have indicated that corticosteroids should be applied when the body's inflammatory response is over activated (i.e. inflammatory cytokine storm). It is necessary to make a comprehensive evaluation based on the patient's vital signs, oxygenation status, and dynamic changes in inflammatory indicators and imaging examinations. We hope that through our first-line experience and preliminary meta-analysis, new thoughts could be inspired for 6.9 (4.0, 9.0) 6.8 (5.4, 10.7) 8.1 (6.5, 13.6) 8.7 (5.3, 11.5) The data were presented as median (interquartile range) a and frequency (%) b . SaO 2 : oxygen saturation; PaO 2 /FiO 2 : the ratio of arterial oxygen tension to inspiratory oxygen fraction; WBC: white blood cell. All comparisons were compared with Day 1 group. * P<0.05 was statistically significant. 63 of records excluded after two authors independently assessed full texts 10 unable to extract data 38 unable to match the research content 12 editorials, reviews, or expert consensus 1 duplicated 1 retracted 1 unable to obtain full text 6 included studies Ruan et al [8] Wang et al [9] Yang et al [10] Guan et al [11] future researchers. Strictly following the indications of corticosteroid use, avoiding the occurrence of adverse events, and applying a more standardized and reasonable regimen of corticosteroids need not only to be proved by scientific evidence but also to be tested by the practical experience of front-line experts of multiple disciplines. Fig. 2 Forest plot of corticosteroid therapy on COVID-19 patients. A: The use of corticosteroids in critical and non-critical patients. B: Effect of corticosteroids on improvement/stabilization. C: Effect of corticosteroids on mortality. OR: odds ratios; CI: confidence interval. 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