COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Yang Z, Liu J, Zhou Y, et al. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. J Infect. 2020 Jul;81(1):e13-e20. doi: 10.1016/j.jinf.2020.03.062. Epub 2020 Apr 10.

OBJECTIVES: An outbreak of novel coronavirus in 2019 threatens the health of people, and there is no proven pharmacological treatment. Although corticosteroids were widely used during outbreaks of severe acute respiratory syndrome and Middle East respiratory syndrome, their efficacy remainedhighly controversial. We aimed to further evaluate the influence of corticosteroids on patients with coronavirus infection.

METHODS: We conducted a comprehensive search of literature published in PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure (CNKI) from January 1, 2002 to March 15, 2020. All statistical analyses in this study were performed on stata14.0.

RESULTS: A total of 5270 patients from 15 studies were included in this meta-analysis. The result indicated that critical patients were more likely to require corticosteroids therapy (risk ratio [RR]?=?1.56, 95% confidence interval [CI]?=?1.28-1.90, P<0.001). However, corticosteroid treatment was associated with higher mortality (RR?=?2.11, 95%CI?=?1.13-3.94, P?=?0.019), longer length of stay (weighted mean difference [WMD]?=?6.31, 95%CI?=?5.26-7.37, P<0.001), a higher rate of bacterial infection (RR?=?2.08, 95%CI?=?1.54-2.81, P<0.001), and hypokalemia (RR?=?2.21, 95%CI?=?1.07-4.55, P?=?0.032) but not hyperglycemia (RR?=?1.37, 95%CI=0.68-2.76, P = 0.376) or hypocalcemia (RR?=?1.35, 95%CI?=?0.77-2.37, P?=?0.302).

CONCLUSIONS: Patients with severe conditions are more likely to require corticosteroids. Corticosteroid use is associated with increased mortality in patients with coronavirus pneumonia.

Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Intensivist/Critical Care
Comments from MORE raters

Hospital Doctor/Hospitalists rater

This article broadly endorses current practices for managing viral pneumonias.

Infectious Disease rater

This is definitely topical but reproduces what we already DON'T know.

Intensivist/Critical Care rater

The consensus currently is that steroids increase risk of adverse outcome in patients with coronavirus infection. The mechanism is unclear.