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01-05-2021 | Acute Respiratory Distress-Syndrome | Systematic Review

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

Authors: Dipayan Chaudhuri, Kiyoka Sasaki, Aram Karkar, Sameer Sharif, Kimberly Lewis, Manoj J. Mammen, Paul Alexander, Zhikang Ye, Luis Enrique Colunga Lozano, Marie Warrer Munch, Anders Perner, Bin Du, Lawrence Mbuagbaw, Waleed Alhazzani, Stephen M. Pastores, John Marshall, François Lamontagne, Djillali Annane, Gianfranco Umberto Meduri, Bram Rochwerg

Published in: Intensive Care Medicine | Issue 5/2021

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Title: Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis
Authors: Dipayan Chaudhuri
Kiyoka Sasaki
Aram Karkar
Sameer Sharif
Kimberly Lewis
Manoj J. Mammen
Paul Alexander
Zhikang Ye
Luis Enrique Colunga Lozano
Marie Warrer Munch
Anders Perner
Bin Du
Lawrence Mbuagbaw
Waleed Alhazzani
Stephen M. Pastores
John Marshall
François Lamontagne
Djillali Annane
Gianfranco Umberto Meduri
Bram Rochwerg
Publication date: 01-05-2021
Publisher: Springer Berlin Heidelberg
Keywords: Acute Respiratory Distress-Syndrome
COVID-19
Published in: Intensive Care Medicine / Issue 5/2021
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-021-06394-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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