Corticosteroids in COVID-19; is it rational? A systematic review and meta-analysis

Abstract Background Due to a lack of definitive treatment, many drugs were repurposed for COVID-19 treatment, among them corticosteroid is one. However, its benefit or harm while treating COVID-19 is not fully studied. Thus, we conducted this meta-analysis to assess the rationality on the use of corticosteroids in COVID-19. Methods Pubmed, Medline, Clinicaltrials.gov, Cochrane library, and Preprint publisher were searched. In the qualitative synthesis, 41 and quantitative 40 studies were included using PRISMA guidelines. Assessment of heterogeneity was done using the I-squared (I 2 ) test and random/fixed-effect analysis was done to determine the odds/risk ratio. Results We found severely ill COVID-19 patients almost 5 (OR 4.78, 2.76-8.26) times higher odds of getting corticosteroids during their treatment. Similarly, the odds for corticosteroids in addition to standard of care (SOC) were approximately 4 (OR 4.09, 1.89-8.84) times higher among intensive care unit (ICU) patients than non-ICU ones. A higher mortality risk with corticosteroids receiving group compared with the SOC alone (RR 2.01, 1.12-3.63) was observed. Niether increased discharge rate (RR 0.79, 0.63-0.99) nor recovery/ improvement rate was shown among corticosteroids group (OR 0.24, 0.13-0.43). Approximately, the overall 4 days longer hospital stay was found among the treatment groups (MD 4.19, 2.57-5.81). For the negative conversion of reverse transcription- polymerase chain reaction (RT-PCR), approximately 3 days (MD 2.42, 1.31-3.53) delay was observed with corticosteroids treatment cases. Conclusion Our study concludes that more severe and critically ill patients tend to get corticosteroids and the mortality risk increases with the use of corticosteroids. With the use of corticosteroids, delayed recovery and a longer hospital stay were observed.