key: cord-293535-9bj5ev1a
authors: Wang, Yushu; Ao, Guangyu; Qi, Xin; Zeng, Jian
title: The influence of corticosteroid on patients with COVID-19 infection: A meta-analysis
date: 2020-06-23
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.06.040
sha: 
doc_id: 293535
cord_uid: 9bj5ev1a

nan

J o u r n a l P r e -p r o o f (SARS-CoV) and Middle Eastern respiratory syndrome (MERS)-CoV and did not investigate the effect of corticosteroids on mortality in COVID-19 patients. With an increased number of COVID-19 literature now published, it has enabled a more robust and profound analysis of current data which is urgently needed by the international medical and scientific communities. Therefore, we aim to perform this meta-analysis to identify the roles of corticosteroids in patients with or without severe COVID-19.

An electronic search was performed in Pubmed, Embase, Cochrane library, and China National Knowledge Infrastructure (CNKI), using the keywords "steroid" or "corticosteroid" or "cortisol" or "prednisolone" or "prednisone" or "glucocorticoid" or "hydrocortisone" or "dexamethasone" or "methylprednisolone" AND "novel coronavirus" or "2019-nCoV" or "COVID-19" or "SARS-CoV-2" between 2019 and present time (i.e., up to May 7th, 2020) and without language restrictions. The inclusion criteria for studies were as follows: (1) studies comparing the use of corticosteroids between severe and non-severe COVID-19 patients; (2) patients must be diagnosed with COVID-19 infection and (3) Abstracts, case reports, review articles, editorials or letters were excluded. The title, abstract and full text of all documents identified according to these search criteria were assessed independently by two reviewers (Y.W. and G.A.). A meta-analysis was then carried out for calculating the individual and pooled risk ratios (RR) with their relative 95% confidence interval (95% CI), using RevMan 5.3 (Cochrane Collaboration). Heterogeneity among studies was evaluated using Cochran's Q test and the I 2 statistic, with an I 2 less than 25%, 25% to J o u r n a l P r e -p r o o f 50%, and greater than 50% corresponding to low, moderate, and high heterogeneity, respectively. P < 0.05 was considered statistically significant.

A total of 466 studies were originally identified based on our search criteria, 411 of which were excluded after title, abstract or full text reading since they were review articles, editorial materials or letters, and did not report the use of corticosteroid in patients with or without severe COVID-19. Thus, 16 studies were finally included in our meta-analysis [5-20]. The study population ranged from 30 to 1,099. The details of each included study are shown in Table 1 . The pooled RR of these studies is presented in Figure 1 . Although the heterogeneity was considerably high (i.e., I 2 , 88%; P ＜ 0.00001), severe patients were found to be more likely to require corticosteroids therapy (RR = 2.11, 95%CI = 1.53-2.92, P ＜ 0.00001). In addition, no statistically 

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