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Efficacy of Cortico...
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Lee, Keum HwaYonsei Univ, South Korea
(author)
Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis
- Article/chapterEnglish2020
Publisher, publication year, extent ...
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2020-07-27
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MDPI,2020
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electronicrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:liu-170010
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https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-170010URI
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https://doi.org/10.3390/jcm9082392DOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:144536844URI
Supplementary language notes
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Language:English
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Summary in:English
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Classification
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Subject category:ref swepub-contenttype
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Subject category:for swepub-publicationtype
Notes
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(1) Background: The use of corticosteroids in critical coronavirus infections, including severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), or Coronavirus disease 2019 (COVID-19), has been controversial. However, a meta-analysis on the efficacy of steroids in treating these coronavirus infections is lacking. (2) Purpose: We assessed a methodological criticism on the quality of previous published meta-analyses and the risk of misleading conclusions with important therapeutic consequences. We also examined the evidence of the efficacy of corticosteroids in reducing mortality in SARS, MERS and COVID-19. (3) Methods: PubMed, MEDLINE, Embase, and Web of Science were used to identify studies published until 25 April 2020, that reported associations between steroid use and mortality in treating SARS/MERS/COVID-19. Two investigators screened and extracted data independently. Searches were restricted to studies on humans, and articles that did not report the exact number of patients in each group or data on mortality were excluded. We calculated odds ratios (ORs) or hazard ratios (HRs) under the fixed- and random-effect model. (4) Results: Eight articles (4051 patients) were eligible for inclusion. Among these selected studies, 3416 patients were diagnosed with SARS, 360 patients with MERS, and 275 with COVID-19; 60.3% patients were administered steroids. The meta-analyses including all studies showed no differences overall in terms of mortality (OR 1.152, 95% CI 0.631-2.101 in the random effects model,p= 0.645). However, this conclusion might be biased, because, in some studies, the patients in the steroid group had more severe symptoms than those in the control group. In contrast, when the meta-analysis was performed restricting only to studies that used appropriate adjustment (e.g., time, disease severity), there was a significant difference between the two groups (HR 0.378, 95% CI 0.221-0.646 in the random effects model,p< 0.0001). Although there was no difference in mortality when steroids were used in severe cases, there was a difference among the group with more underlying diseases (OR 3.133, 95% CI 1.670-5.877,p< 0.001). (5) Conclusions: To our knowledge, this study is the first comprehensive systematic review and meta-analysis providing the most accurate evidence on the effect of steroids in coronavirus infections. If not contraindicated, and in the absence of side effects, the use of steroids should be considered in coronavirus infection including COVID-19.
Subject headings and genre
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Yoon, SojungYonsei Univ, South Korea
(author)
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Jeong, Gwang HunGyeongsang Natl Univ, South Korea
(author)
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Kim, Jong YeobYonsei Univ, South Korea
(author)
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Han, Young JooSungkyunkwan Univ, South Korea
(author)
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Hong, Sung HwiHarvard TH Chan Sch Publ Hlth, MA 02115 USA
(author)
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Ryu, SeohyunYonsei Univ, South Korea
(author)
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Kim, Jae SeokYonsei Univ, South Korea
(author)
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Lee, Jun YoungYonsei Univ, South Korea
(author)
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Yang, Jae WonYonsei Univ, South Korea
(author)
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Lee, JinheeYonsei Univ, South Korea
(author)
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Solmi, MarcoUniv Padua, Italy
(author)
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Koyanagi, AiCIBERSAM, Spain; ICREA, Spain
(author)
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Dragioti, ElenaLinköpings universitet,Avdelningen för prevention, rehabilitering och nära vård,Medicinska fakulteten,Region Östergötland, Smärt och rehabiliteringscentrum(Swepub:liu)eledr71
(author)
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Jacob, LouisCIBERSAM, Spain; Univ Versailles St Quentin En Yvelines, France
(author)
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Radua, JoaquimKarolinska Institutet
(author)
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Smith, LeeAnglia Ruskin Univ, England
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Oh, HansUniv Southern Calif, CA 90015 USA
(author)
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Tizaoui, KalthoumTunis El Manar Univ, Tunisia
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Cargnin, SarahUniv Piemonte Orientale, Italy
(author)
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Terrazzino, SalvatoreUniv Piemonte Orientale, Italy; Univ Piemonte Orientale, Italy
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Abou Ghayda, RamyHarvard TH Chan Sch Publ Hlth, MA 02115 USA; Brigham & Womens Hosp, MA 02115 USA; Harvard Med Sch, MA 02115 USA
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Kronbichler, AndreasMed Univ Innsbruck, Austria
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Shin, Jae IlYonsei Univ, South Korea
(author)
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Yonsei Univ, South KoreaGyeongsang Natl Univ, South Korea
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In:Journal of Clinical Medicine: MDPI9:82077-0383
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- By the author/editor
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Lee, Keum Hwa
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Yoon, Sojung
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Jeong, Gwang Hun
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Kim, Jong Yeob
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Han, Young Joo
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Hong, Sung Hwi
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Ryu, Seohyun
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Kim, Jae Seok
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Lee, Jun Young
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Yang, Jae Won
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Lee, Jinhee
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Solmi, Marco
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Koyanagi, Ai
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Dragioti, Elena
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Jacob, Louis
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Radua, Joaquim
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Smith, Lee
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Oh, Hans
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Tizaoui, Kalthou ...
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Cargnin, Sarah
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Terrazzino, Salv ...
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Abou Ghayda, Ram ...
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Kronbichler, And ...
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Shin, Jae Il
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
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Journal of Clini ...
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Linköping University
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Karolinska Institutet