Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use : a systematic review and meta-analysis

OBJECTIVES: The acute respiratory distress syndrome (ARDS) secondary to viral pneumonitis is one of the main causes of high mortality in patients with COVID-19 (novel coronavirus disease 2019). We systematically reviewed mortality in COVID-19 patients with ARDS and the potential role of systemic corticosteroids in COVID-19 patients.

METHODS: Electronic databases and country-specific healthcare databases were searched to identify relevant studies/reports. The quality assessment of individual studies was conducted using the Newcastle-Ottawa Scale. Country-specific proportion of individuals with COVID-19 who developed ARDS and reported death were combined in a random-effect meta-analysis to give a pooled mortality estimate of ARDS.

RESULTS: The overall pooled mortality estimate among 10,815 ARDS cases in COVID-19 patients was 39% (95% CI: 23-56%). The pooled mortality estimate for China was 69% (95% CI: 67-72%). In Europe, the highest mortality estimate among COVID-19 patients with ARDS was reported in Poland (73%; 95% CI: 58-86%) while Germany had the lowest mortality estimate (13%; 95% CI: 2-29%) among COVID-19 patients with ARDS. The median crude mortality rate of COVID-19 patients with reported corticosteroid use was 28.0% (lower quartile: 13.9%; upper quartile: 53.6%).

CONCLUSIONS: The high mortality in COVID-19 associated ARDS necessitates a prompt and aggressive treatment strategy which includes corticosteroids. Most of the studies included no information on the dosing regimen of corticosteroid therapy, however, low-dose corticosteroid therapy or pulse corticosteroid therapy appears to have a beneficial role in the management of severely ill COVID-19 patients.

Media Type:

Electronic Article

Year of Publication:

2020

Contained In:

Expert review of respiratory medicine - Vol. 14, No. 11 (2020), p. 1149-1163

Language:

English

Contributors:

Hasan, Syed Shahzad
Capstick, Toby
Ahmed, Raees
Kow, Chia Siang
Mazhar, Faizan
Merchant, Hamid A
Zaidi, Syed Tabish Razi

Links:

Volltext

Keywords:

*Betacoronavirus
Acute respiratory distress syndrome
Adrenal Cortex Hormones
Coronavirus Infections
Coronavirus disease 2019
Corticosteroids
Humans
Journal Article
Meta-Analysis
Mortality
Pandemics
Pneumonia, Viral
Respiratory Distress Syndrome, Adult
Systematic Review

Notes:

Date Completed 04.11.2020

Date Revised 04.11.2020

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1080/17476348.2020.1804365

PMID:

32734777

PPN (Catalogue-ID):

NLM314029397