Table 1. Characteristics of included studies.
| Study ID | R/P | Study design | Disease | Severity of disease | Population | Number of patients | Age, years | Gender (male/female) | Type, dose and duration of glucocorticoid therapy | Outcomes | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| I | C | I | C | ||||||||||
| Meng 2003 (29) | R | Cohort | SARS | N/A | Adult | 70 | 33±15 | 18/70 | Methylprednisolone, low dose for 40–80 mg/d; mild dose for 120–240 mg/d; high dose for 320–640 mg/d. The dosage reduced from 10–15 d, 1/3–1/2 should be subtracted for the first time, according to the severity of the disease, 1/2 of the applied dose should be decreased for every 3 to 5 d. When most of the lesion is absorbed, the patient can be discharged with the drug (20 mg/d prednisone) | ①④⑫ | |||
| Peng 2004 (30) | R | Cohort | SARS | Mild/severe | Both | 99 | 38.9 | 37.6 | 22/46 | 27/53 | Dexamethasone 10 mg/d; methylprednisolone 80 mg/d, 3–8 d. | ①②③⑫ | |
| Wang 2004 (31) | R | Cohort | SARS | N/A | Both | 1,291 | 37±15 | 36±17 | 500/1,084 | 121/207 | Methylprednisolone | ① | |
| Wang 2005 (32) | R | Cohort | SARS | N/A | Both | 241 | 35±12 | 32±16 | 94/192 | 29/49 | Methylprednisolone, dexamethasone and hydrocortisone. | ①②④ | |
| Chen 2006 (33) | R | Cohort | SARS | Mild/severe | Both | 401 | 34.7±13.3 | 129/401 | – | Noncritical, 105.3±86.1 mg/d; Critical, 133.5±102.3 mg/d | |||
| Yam 2007 (34) | R | Cohort | SARS | N/A | Adult | 1,287 | 60.7±30.4 | 1021/1,188 | 56/99 | Hydrocortisone; intravenous methylprednisolone; oral prednisolone; intravenous pulsed corticosteroid ≥500 mg/d. Rescue pulse is defined as intravenous methylprednisolone administered at 500 mg or more per dose for at least 1 d started after at least 1 d of corticosteroid treatment |
|||
| Ma 2008 (35) | R | Cohort | SARS | Mild/severe | Both | 4,887 | 37.4±15.3 | 36.1±17.5 | 1703/3,612 | 670/1,275 | Prednisone, dexamethasone, hydrocortisone, prednisolone, etc. | ①②④⑫ ⑬⑭⑮ |
|
| Lau 2009 (36) | R | Cohort | SARS | N/A | Adult | 1,889 | >16 | 327/829 | 504/1,060 | Corticosteroids | |||
| Arabi 2018 (37) | R | Cohort | MERS | Severe | Adult | 309 | 57.8±17.2 | 55.3±17.3 | 107/151 | 106/158 | Hydrocortisone, 3 d | ①④⑤ | |
| Zhou 2020 (38) | R | Cohort | COVID-19 | All | Adult | 191 | 56.3±15.7 | 119/72 | Corticosteroids | ||||
| Wu 2020 (39) | R | Cohort | COVID-19 | Severe | Adult | 201 | 51.3±12.7 | 128/73 | Methylprednisolone | ||||
| Wang 2020 (40) | R | Cohort | COVID-19 | Severe | Adult | 46 | 55.0±11.8 | 54.7±12.0 | 16/10 | 10/10 | Methylprednisolone | ①② | |
| Shang 2020 (41) | R | Cohort | COVID-19 | Mild/severe | Adult | 416 | 48.7±18.6 | 197/219 | Methylprednisolone | ①④ | |||
| Ding 2005 (42) | R | Cohort | SARS | Mild/severe | Mixed | 409 | 36.8±14.4 | 170/409 | – | Methylprednisolone | ②③ | ||
| Ni 2020 (43) | R | Cohort | COVID-19 | Mild/severe | Adult | 72 | 53.0±13.0 | 44.7±19.1 | 29/22 | 12/9 | Methylprednisolone | ③ | |
| He 2003 (44) | R | Cohort | SARS | N/A | Both | 98 | 8–72† | 46/98 | – | Methylprednisolone 80–480 mg/d, 5–7 d; change to prednisolone when reduced to 40 mg/d; reduce 5 mg every 3–5 d until discontinued | ⑩⑪⑫ | ||
| Shen 2006 (45) | R | Cohort | SARS | N/A | Adult | 148 | N/A | 32/148 | – | Prednisone 59 mg/d (mean); 2–87 d, 24 d (mean) | ⑯ | ||
| Hu 2004 (46) | R | Cohort | SARS | N/A | Both | 214 | 40.8±17.3 | 38.9±18.8 | 80/156 | 32/58 | Methylprednisolone (mean dose 187 mg/d, maximum dose 1,000 mg/d); gradually reduce the dose and switch to oral prednisone (5–50 mg/d, mean dose 23 mg/d); The average duration of glucocorticoids use during hospitalization was 24.38 d | ⑥ | |
| Jin 2004 (47) | R | Cohort | SARS | Mild/severe | Adult | 58 | 18–78† | 27/58 | – | Methylprednisolone 80–320 mg/d. Dosage can be appropriately increased if necessary, large dosage time should not be too long. The specific dosage is adjusted according to the condition, and the dosage is gradually reduced and discontinued after the remission of the condition or the absorption of the chest film shadow | ⑧ | ||
| Lee 2004 (48) | P | RCT | SARS | N/A | Adult | 16 | 22–57† | 2/9 | 2/7 | Hydrocortisone 100 mg/q8h for 12 d. Until “pulse” methylprednisolone was given as rescue therapy. “Pulse” of intravenous high-dose methylprednisolone (500 mg/d for three consecutive days) was given for cases having persistent/recurrent fever plus radiographic progression of lung opacities ± hypoxemia as rescue therapy | ① | ||
| Li 2004 (49) | R | Cohort | SARS | N/A | Both | 1,291 | 37±15 | 36±17 | 500/1,084 | 121/207 | Methylprednisolone [early average daily dose (median): 160 mg/d]; After 10 d it went down to 80 mg/d in 13 d and 40 mg/d in 21 d | ⑦ | |
| Zhou 2004 (50) | R | Cohort | SARS | N/A | Adult | 103 | 36±12 | 35±14 | 23/39 | 41/64 | Methylprednisolone 80–320 mg/d, duration (12±4) d | ② | |
| Auyeung 2005 (51) | R | Cohort | SARS | Mild | Adult | 78 | 18–89† | 43–95† | 27/66 | 6/12 | Hydrocortisone 10 mg/kg/d; or methylprednisolone 1–3 mg/kg/d; or pulse intravenous methylprednisolone 500–1,000 mg/d, 2–3 d | ⑨ | |
Outcomes: ①, mortality; ②, duration of fever; ③, lung inflammation absorption time ; ④, length of stay; ⑤, virus clearance; ⑥, fasting blood glucose levels; ⑦, maximum blood glucose levels; ⑧, elevated intraocular pressure; ⑨, LDH peak; ⑩, hypokalemia; ⑪, hypocalcemia; ⑫, infection; ⑬, MODS (multiple organ dysfunction syndrome); ⑭, DIC (disseminated intravascular coagulation); ⑮, ARDS (acute respiratory distress syndrome); ⑯, ONFH (osteonecrosis of the femoral head). †, minimum and maximum. I, intervention; C, Control; R/P, retrospective/prospective.