Therapeutic Effect Of Corticosteroids As Adjunctive Therapy In The Treatment Of COVID-19:a Meta-Analysis

Objective:Gluocorticoid is one of the commonly used drugs for viral pneumonia,but its effect on the clinical outcome of patients with COVID-19 has not been determined yet.This paper aims to systematically evaluate the efficacy and potential adverse reactions of glucocorticoid adjuvant therapy for COVID-19,in order to serve the clinical purpose.Methods:Formulate appropriate retrieval strategies,retrieval strategy should contain COVID-19 and glucocorticoids related key words,use keywords joint free word,computer English database search Pub Med,EMbase,the Cochrane Library and Chinese China hownet database(CNKI),a database of ten thousand,VIP,Chinese biomedical literature database(CBM)and Chinese clinical trial registry and the clinical trial registry(ClinicalTrials.Gov),and through the way of manual retrieval to source,supplement the relevant references.The retrieval time is from December 2019 to March 2021,in any language.Two investigators independently screened the literature according to the established inclusion and exclusion criteria,evaluated the quality of the included literature using the Cochrane bias risk assessment tool and the modified Jadad scoring scale,and extracted the data according to a predetermined table.If there was a dispute,it was resolved by negotiation or third party arbitration.Meta-analysis was performed using Review Manager 5.4.Results:A total of 9 randomized controlled studies were included,including 7907 patients with COVID-19,including 2940 patients treated with adjuvant glucocorticoids and 4967 patients in the control group.Meta-analysis showed that glucocorticoids could significantly reduce the mortality of inpatients [OR=0.84,95%CI(0.75～0.94),P=0.002],and the mortality of patients with invasive mechanical ventilation [OR=0.64,95%CI(0.51～0.81),P=0.0002].And reduced the need for invasive mechanical ventilation [OR=0.71,95%CI(0.56～0.89),P=0.003] and the incidence of comprehensive end outcomes [OR=0.48,95%CI(0.27～0.85),P=0.01].However,for patients who did not receive invasive mechanical ventilation,mortality [OR=0.95,95%CI(0.83～1.08),P=0.43],secondary infection rate[OR=0.87,95%CI(0.61～1.25),P=0.46],incidence of hyperglycemia [OR=1.28,95% CI(0.3～5.4),P=0.74] had no significant effect.Subgroup analysis found that moderate dose of hormone significantly reduced mortality in COVID-19 patients [OR=0.85,95%CI(0.75～0.95),P=0.005],while high dose of hormone therapy had no significant effect on mortality in COVID-19 patients [OR=0.91,95%CI(0.68～1.21)].P = 0.51).Dexamethasone treatment significantly reduced mortality in COVID-19 patients [OR=0.86,95%CI(0.76～0.97),P=0.01],while methylprednisolone and hydrocortisone had no significant effect [OR=0.96,95%CI(0.65～1.41)].P=0.83],[OR=0.69,95%CI(0.45～1.04),P=0.08].Conclusion:Adjuvant treatment of glucocorticoid COVID-19 can reduce overall mortality in hospitalized patients,but different hormone types,dosage,and the curative effect of patients with hormone crowd has a lot to do,to be further lines of large sample size of randomized controlled trials to validate these findings,and deal with small dose of hormone and shock dose hormone therapy COVID-19 aspects to do more research,To see if it could benefit patients with COVID-19.