Corticosteroids for Patients With Coronavirus Disease 2019 (COVID-19) With Different Disease Severity: A Meta-Analysis of Randomized Clinical Trials.
Corticosteroids for Patients With Coronavirus Disease 2019 (COVID-19) With Different Disease Severity: A Meta-Analysis of Randomized Clinical Trials.
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DOI：
10.1053/j.jvca.2020.11.057
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发表时间：
2021-03
影响因子：
2.8
通讯作者：
Landoni G
中科院分区：
文献类型：
--
作者：
Pasin L;Navalesi P;Zangrillo A;Kuzovlev A;Likhvantsev V;Hajjar LA;Fresilli S;Lacerda MVG;Landoni G
皮质类固醇在2019-nCoV（2019新型冠状病毒）感染患者中的有效性和安全性仍存在争议。由于最近发表了关于使用皮质类固醇的大型随机临床试验（RCT）和进行良好的荟萃分析，重点关注重症监护病房中的冠状病毒病（COVID-19）患者，因此对不同疾病严重程度患者的皮质类固醇治疗进行了RCT荟萃分析，以评估对生存的影响。对RCT进行了荟萃分析。患者入院。冠状病毒病患者。给予皮质类固醇。检索了接受皮质类固醇与任何对照药物治疗的2019-nCoV感染相关急性低氧血症衰竭成人患者的RCT。主要终点为死亡率。纳入了5项RCT，涉及7，692例患者。接受皮质类固醇治疗的患者的总体死亡率略低于对照组，但显著低于对照组（26% vs28%，相对风险{RR} = 0.89 [95%置信区间{CI} 0.82-0.96]，p = 0.003）。在需要机械通气的患者亚组中发现了相同的有益效果（RR = 0.85 [95% CI 0.72-1.00]，p = 0.05，需要治疗的人数{NNT} = 19）。值得注意的是，在不需要氧气的患者亚组中，皮质类固醇增加了死亡率（17% vs 13%，RR = 1.23 [95% CI 1.00-1.62]，p = 0.05，需要伤害的人数{NNH} = 29）。对机械通气亚组和不需要氧气亚组进行比较的试验证实，皮质类固醇治疗对生存率的影响具有统计学显著性差异。接受皮质类固醇治疗的患者需要机械通气的风险显著降低。COVID-19重症患者可考虑使用皮质类固醇，但不鼓励不需要氧疗的患者使用皮质类固醇。在全球范围内实施这种治疗之前，迫切需要进一步的试验。
Efficacy and safety of corticosteroids in patients with 2019-nCoV (novel coronavirus 2019) infection still are debated. Because large randomized clinical trials (RCTs) and a well-conducted meta-analysis on the use of corticosteroids, focused on patients with coronavirus disease (COVID-19) in intensive care units, recently were published, a meta-analysis of RCTs on corticosteroids therapy in patients with different disease severity was performed to evaluate the effect on survival. A meta-analyses of RCTs was performed. Patients admitted to hospital. Patients with coronavirus disease. Administration of corticosteroids. A search was performed for RCTs of adult patients with acute hypoxemic failure related to 2019-nCoV infection who received corticosteroids versus any comparator. The primary endpoint was mortality rate. Five RCTs involving 7,692 patients were included. Overall mortality of patients treated with corticosteroids was slightly but significantly lower than mortality of controls (26% v 28%, relative risk {RR} = 0.89 [95% confidence interval {CI} 0.82-0.96], p = 0.003). The same beneficial effect was found in the subgroup of patients requiring mechanical ventilation (RR = 0.85 [95% CI 0.72-1.00], p = 0.05 number needed to treat {NNT} = 19). Remarkably, corticosteroids increased mortality in the subgroup of patients not requiring oxygen (17% v 13%, RR = 1.23 [95% CI 1.00-1.62], p = 0.05 number needed to harm {NNH} = 29). Tests for comparison between mechanically ventilated subgroups and those not requiring oxygen confirmed that treatment with corticosteroids had a statistically significant different effect on survival. Patients treated with corticosteroids had a significantly lower risk of need for mechanical ventilation. Corticosteroids may be considered in severe critically ill patients with COVID-19 but must be discouraged in patients not requiring oxygen therapy. Urgently, further trials are warranted before implementing this treatment worldwide.
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影响因子：
11.8
作者：
Fadel, Raef;Morrison, Austin R.;Ramesh, Mayur S.
通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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DOI：
10.15360/1813-9779-2020-3-0-2
发表时间：
2020-01-01
期刊：
General Reanimatology
影响因子：
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作者：
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通讯作者：
Landoni, G.
影响因子：
120.7
作者：
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