Background: The response to glucocorticoids treatment may be different between Covid-19 and SARS. Methods: In this systematic review and meta-analysis, we searched studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, ClinicalTrials.gov, ICTRP from 2002 to October 7, 2020. We used fixed-effects and random-effects models to compute the risk ratio of death in the group receiving glucocorticoids treatment and the control group for COVID-19 and SARS, respectively. Results: Ten trials and 71 observational studies, with a total of 45935 patients, were identified. Glucocorticoids treatment, was associated with decreased all-cause mortality both in COVID-19 (risk ratio, 0.88;95% confidence interval, 0.82 to 0.94;I 2 =26%) and SARS (0.48;0.29 to 0.79;10%), based on high quality evidence, as well as decreased all-cause mortality-including composite outcome of COVID-19 (0.89;0.82 to 0.98;0%). In subgroup analyses, all-cause mortality was significantly lower among COVID-19 patients being accompanied by severe ARDS but not mild ARDS, taking low-dose or pulse glucocorticoids, being critically severe but not only severe, being of critical severity and old but not young, being of critical severity and men but not women, non-early taking glucocorticoids and taking dexamethasone or methylprednisolone;but for SARS, lower mortality were observed among those who were taking medium-high dose glucocorticoids, being severe or critically severe, early taking glucocorticoids, and taking dexamethasone or prednisolone. Conclusions: Glucocorticoids treatment reduced mortality in COVID-19 and SARS patients of critical severity;however, different curative effects existed between the two diseases among subpopulations, mainly regarding sex- and age-specific effects, optimal doses and use timing of glucocorticoids.
Comparison of Associations Between Glucocorticoids Treatment and Mortality in COVID-19 Patients and SARS Patients: A Systematic Review and Meta-Analysis