Systemic administration of glucocorticoids, cardiovascular complications and mortality in patients hospitalised with COVID-19, SARS, MERS or influenza: A systematic review and meta-analysis of randomised trials

• Published in: Pharmacological research Vol. 176; p. 106053
• Main Authors: Caiazzo, Elisabetta, Rezig, Asma O.M., Bruzzese, Dario, Ialenti, Armando, Cicala, Carla, Cleland, John G.F., Guzik, Tomasz J., Maffia, Pasquale, Pellicori, Pierpaolo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2022; Elsevier
• Subjects: Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Coronavirus Infections - drug therapy; Coronavirus Infections - mortality; COVID-19; COVID-19 - drug therapy; COVID-19 - mortality; Dexamethasone; Glucocorticoids; Glucocorticoids - therapeutic use; Hospitalization; Humans; Influenza, Human - drug therapy; Influenza, Human - mortality; Meta-analysis; Mortality; Randomized Controlled Trials as Topic; SARS-CoV-2 - drug effects; Severe Acute Respiratory Syndrome - drug therapy; Steroids; COVID-19; Dexamethasone; Glucocorticoids; Mortality; Steroids; Meta-analysis
• ISSN: 1043-6618; 1096-1186
• DOI: 10.1016/j.phrs.2021.106053

Administration of glucocorticoids might reduce mortality in patients with severe COVID-19 but have adverse cardiometabolic effects. to investigate the effect of systemic administration of glucocorticoids on cardiovascular complications and all-cause mortality in patients hospitalised with respiratory viral infections, including COVID-19, SARS, MERS and influenza. We identified randomised trials published prior to July 28th, 2021. The Mantel-Haenszel random effects method and the Hartung and Knapp adjustment were used to obtain pooled estimates of treatment effect with 95% confidence intervals. No randomised trials of glucocorticoids for SARS, MERS or influenza reported relevant outcomes. We included eleven COVID-19 randomised trials (8109 patients). Overall, compared to placebo or standard care, glucocorticoids were not associated with a reduction of in-hospital mortality (p = 0.09). In a pre-specified sub-analysis, in-hospital mortality was reduced by 19% when follow-up was restricted to 14 days from randomisation (5/11 trials, 1329 patients, p = 0.02). With longer follow-up (9/11 trials, 7874 patients), administration of glucocorticoids was associated with a trend to benefit for those requiring mechanical ventilation (RR 0.86; 95% CI 0.57–1.27) but possible harm for those not receiving oxygen at randomisation (RR 1.27; 95% CI 1.00 – 1.61), an effect that was significantly different amongst subgroups (p = 0.0359). Glucocorticoids reduced the risk of worsening renal function by 37% (4/11 trials); reported rate of other cardiovascular complications was low. Administration of systemic glucocorticoids to patients hospitalised with COVID-19 does not lower mortality overall but may reduce it in those requiring respiratory support and increase it in those who do not. [Display omitted]