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Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis
- Source :
- Sterne, J A C, Murthy, S, Diaz, J, Slutsky, A S, Villar, J, Angus, D C, Annane, D, Azevedo, L C P, Berwanger, O, B Cavalcanti, A, Dequin, P-F, Du, B, Emberson, J R, Fisher, D, Giraudeau, B, Gordon, A C, Granholm, A, Green, C, Haynes, R, Heming, N, Higgins, J P T, Horby, P, Juni, P, Landray, M J, Le Gouge, A, Leclerc, M, Lim, W S, R Machado, F, McArthur, C, Meziani, F, Møller, M H, Perner, A, Petersen, M W, Savović, J, Tomazini, B, C Veiga, V, Webb, S & C Marshall, J 2020, ' Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19 : A Meta-analysis ', JAMA-Journal of the American Medical Association, vol. 324, no. 13, pp. 1330-1341 . https://doi.org/10.1001/jama.2020.17023, JAMA
- Publication Year :
- 2020
-
Abstract
- IMPORTANCE: Effective therapies for patients with coronavirus disease 2019 (COVID-19) are needed, and clinical trial data have demonstrated that low-dose dexamethasone reduced mortality in hospitalized patients with COVID-19 who required respiratory support. OBJECTIVE: To estimate the association between administration of corticosteroids compared with usual care or placebo and 28-day all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS: Prospective meta-analysis that pooled data from 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19. The trials were conducted in 12 countries from February 26, 2020, to June 9, 2020, and the date of final follow-up was July 6, 2020. Pooled data were aggregated from the individual trials, overall, and in predefined subgroups. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I(2) statistic. The primary analysis was an inverse variance–weighted fixed-effect meta-analysis of overall mortality, with the association between the intervention and mortality quantified using odds ratios (ORs). Random-effects meta-analyses also were conducted (with the Paule-Mandel estimate of heterogeneity and the Hartung-Knapp adjustment) and an inverse variance–weighted fixed-effect analysis using risk ratios. EXPOSURES: Patients had been randomized to receive systemic dexamethasone, hydrocortisone, or methylprednisolone (678 patients) or to receive usual care or placebo (1025 patients). MAIN OUTCOMES AND MEASURES: The primary outcome measure was all-cause mortality at 28 days after randomization. A secondary outcome was investigator-defined serious adverse events. RESULTS: A total of 1703 patients (median age, 60 years [interquartile range, 52-68 years]; 488 [29%] women) were included in the analysis. Risk of bias was assessed as “low” for 6 of the 7 mortality results and as “some concerns” in 1 trial because of the randomization method. Five trials reported mortality at 28 days, 1 trial at 21 days, and 1 trial at 30 days. There were 222 deaths among the 678 patients randomized to corticosteroids and 425 deaths among the 1025 patients randomized to usual care or placebo (summary OR, 0.66 [95% CI, 0.53-0.82]; P
- Subjects :
- medicine.medical_specialty
Hydrocortisone
Critical Illness
UNCOVER
Pneumonia, Viral
Placebo
01 natural sciences
Methylprednisolone
Dexamethasone
law.invention
03 medical and health sciences
Betacoronavirus
0302 clinical medicine
Randomized controlled trial
law
Interquartile range
Adrenal Cortex Hormones
Internal medicine
Cause of Death
medicine
Humans
030212 general & internal medicine
0101 mathematics
Adverse effect
Glucocorticoids
Pandemics
Original Investigation
Randomized Controlled Trials as Topic
business.industry
SARS-CoV-2
010102 general mathematics
COVID-19
Covid19
General Medicine
Odds ratio
COVID-19 Drug Treatment
Clinical trial
Relative risk
Meta-analysis
business
Coronavirus Infections
Subjects
Details
- ISSN :
- 15383598
- Volume :
- 324
- Issue :
- 13
- Database :
- OpenAIRE
- Journal :
- JAMA
- Accession number :
- edsair.doi.dedup.....61d64618bb6a97bf6370055fc074fc5a
- Full Text :
- https://doi.org/10.1001/jama.2020.17023