Table 1.
Characteristics of included studies presenting proportion of COVID-19 patients with ARDS and COVID-19 patients receiving corticosteroids.
| Study | Region, Country | Study Type | Study Site | Agea | Study Period | No. of patients | No. of patients with ARDS | No. of deaths in patients with ARDS | Corticosteroids dosing regimen | Mortality in corticosteroids group n/N (%) |
NOS Quality Scoreb |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Wu et. al [31] | Wuhan, China | Retrospective cohort study | Single center | 51 (43–60) | 25 December 2019–13 February 2020 | 201 | 84 | 44 | MTP, dose not mentioned | 23/50 (46.0) | 7 |
| Chen N et. al [32] | Wuhan, China | Retrospective cohort study | Single center | M(SD): 55.5 (13.1) | Jan 1–20 January 2020 | 99 | 17 | 11 | - | - | 6 |
| Yang et. al [33] | Wuhan, China | Retrospective cohort study | Single center | M(SD): 59.7 (13.3) | 24 December 2019, to 26 January 2020, | 52 | 35 | 26 | No information | 16/30 (53.3) | 7 |
| Zhou et. al [34] | Wuhan, China | Retrospective cohort study | Multicenter | 56 (46–67) | 29 December 2019–31 January 2020 | 191 | 59 | 50 | No information | 26/57 (45.6) | 7 |
| Deng et. al [35] | Wuhan, China | Retrospective cohort study | Multicenter | 54 (47–65) | 1 January 2020– 21 February 2020 |
225 | 108 | 98 | No information | 88/152 (57.9) | 7 |
| Tang et al [36] | Wuhan, China | Retrospective case-control | Single center | 62 (47–69) | 24 December 2019–7 February 2020 | 179 | 73 | 21 | - | - | 6 |
| Wang Yin et al [37] | Wuhan, China | Retrospective cohort study | Single center | 54(48–64) | Jan 20 – Feb 25, 2020 |
46 | - | - | MTP 1–2 mg/kg/d for 5–7 d | 2/26 (7.7) | - |
| Huang C et al [38] | Wuhan, China | Prospective study | Single center | 49 (41–58) | 16 December 2019–2 January 2020 | 41 | - | - | MTP 40–120 mg/d | 4/9 (44.4) | - |
| Wang L et al [39] | Wuhan, China | Prospective study | Single center | 69 (65–76) | Jan 1 – Mac 5, 2020 | 339 | 71 | 56 | - | - | 6 |
| Cao et al [40] | Wuhan, China | Cohort study | Single center | 54(37–67) | Jan 3–1 February 2020 | 102 | 20 | 15 | MTP, dose not mentioned | 11/51 (21.6) | 7 |
| Wang D et al [41] | Wuhan, China | Retrospective case series | Multicenter | 51(36–65) | Jan 1–10 February 2020 | 107 | 28 | 17 | No information | 18/62 (29.0) | 7 |
| Li et al [42] | Wuhan, China | Retrospective cohort study | Single center | M(SD): 51.0 (17.5) | Jan 10–22 February 2020 | 93 | - | - | No information | 21/21 (100) | - |
| Wan et al [43] | Chonqing, China | Retrospective case series | Single center | 47(36–55) | Jan 23–8 February 2020 | 135 | 21 | 1 | - | - | 6 |
| Xu et al [44] | Wuhan, China | Retrospective cohort study | Multicenter | M(SD): 62.5 (13.3) | Jan 12–3 February 2020 | 239 | 164 | 118 | MTP 60.9 ± 21.7 mg/d | 118/189 (62.4) | 7 |
| Chen L et al [45] | Wuhan, China | Retrospective cohort study | Multicenter | 59(45–68) | Jan 20–4 April 2020 | 1859 | 227 | 174 | No information | 165/753 (21.9) | 7 |
| Shi Q et al [46] | Wuhan, China | Retrospective cohort study | Multicenter | Diabetes: 64(56–72) Non-diabetes: 65(56–72) |
Jan 1 – Mac 8, 2020 | 306 | 55 | 47 | No information | 30/107 (28.0) | 7 |
| Chen F et al [47] | Wuhan, China | Retrospective cohort study | Single center | 55(34–68) | Jan 1–15 February 2020 | 660 | - | - | No information | 30/184 (16.3) | - |
| Shi M et al [48] | Hubei, China | Retrospective cohort study | Multicenter | M(SD): 59.4 (16.5) | Jan 1 – Mac 1, 2020 | 161 | 69 | 47 | - | - | 6 |
| Ruan et al [49] | Wuhan, China | Retrospective cohort study | Multicenter | Died: 67(15–81) Discharged: 50(44–81) |
No information | 150 | 62 | 55 | No information | 31/53 (58.5) | 7 |
| Wang Yang et al [50] | Wuhan, China | Retrospective cohort study | Single center | 60(48–69) | Jan 25–25 February 2020 | 344 | 145 | 128 | - | - | 7 |
| Yan et al [51] | Wuhan, China | Retrospective cohort study | Single center | 64(49–73) | Jan 10–24 February 2020 | 48 | - | - | No information | 35/39 (89.7) | - |
| Wang K et al [52] | Wuhan, China | Ambispective cohort study | Single center | Died: 58(46–67) Survived: 67(62–78) |
No information | 548 | 207 | 76 | No information | 65/341 (19.1) | 7 |
| Pan et al [53] | Wuhan, China | Case-control | Single center | 68(61–75) | Jan 27 – Mac 19, 2020 | 124 | 91 | 89 | - | - | 7 |
| Huang M et al [54] | Jiangsu, China | Retrospective cohort study | Multicenter | 57(26–97) | Jan 24–20 April 2020 | 60 | 9 | 0 | No mention of agent used; 40 to 80 mg/d | 0/34 (0) | 6 |
| Jamaati et al [55] | Iran | Descriptive | Single center | - | Up to Mac 3, 2020 | 231 | 72 | 18 | - | - | - |
| Javanian et al [56] | Iran | Retrospective cohort study | Multicenter | M(SD): 60.1 (13.9) | Feb 25 – Mac 17, 2020 | 100 | 4 | 3 | - | - | 7 |
| Yang et al [57] | Montreal, Canada |
Retrospective case series | Single center | - | NC | 15 | - | - | MTP, HYC, DEX, Dose: 40–160 mg/d |
3/15 (20.0) | - |
| Inciardi et al [58] | Lombardy, Italy |
Retrospective cohort study | Single center | M(SD): 67.0 (12.0) | Mar 4 – Mac 25, 2020 | 99 | 19 | 18 | - | - | 7 |
| Zangrillo et al [59] | Milan, Italy | Retrospective case series | Single center | 61(54–69) | Feb 20–2 April 2020 | 73 | 73 | 17 | - | - | 6 |
| Cavalli et al [60] | Milan, Italy | Retrospective cohort study | Single center | Standard treatment: 70(64–78) Anakinra: 62(55–71) |
Mar 2020 | 45 | 45 | 10 | - | - | 7 |
| Dreher et al [61] | Aachen, Germany | Retrospective cohort study | Single center | 65(58–76) | Feb – Mar 2020 | 50 | 24 | 3 | - | - | 6 |
| Nowak et al [62] | Warsaw, Poland | Retrospective cohort study | Single center | M(SD): 63.7 (19.6) | Mar 16–7 April 2020 | 169 | 41 | 30 | - | - | 6 |
| National Public Health Agency of France [68] | France | Sentinel surveillance of COVID-19 patients admitted to intensive care | Nationwide | - | Mar 16–31 May 2020 | 4,007 | 3,185 | 593 | - | - | - |
| National Center of Epidemiology [69] | Spain | Epidemiological survey | Nationwide | - | Up to 12:00 on 21 May 2020 | 250,287 | 5,807 | 2,335 | - | - | - |
| Cruz et al [63] | Madrid, Spain | Retrospective cohort study | Single center | Corticosteroids: M(SD): 65.4 (12.9) Non-corticosteroids: M(SD): 68.1 (15.7) |
Mar 4–7 April 2020 | 463 | - | - | No mention of agents used; pulse therapy or 1 mg/kg/d | 55/396 (13.9) | - |
| Rubio et al [64] | Granada, Spain | Retrospective cohort study | Single center | M(SD): 63.9 (12.9) | - | 92 | - | - | Pulse therapy: MTP 2 mg/kg/d for 3 days, 250 mg/d for 3 days, and 500 mg/d for 3 days | 6/83 (7.2) | - |
| Selvaraj et al [65] | Rhode Island, USA | Case series | Single center | M(SD): 60.0 (15.8) | Apr 16–16 May 2020 | 21 | - | - | DEX 4 mg three times daily for two days, followed by 4 mg twice daily for two days and then 4 mg once daily for two days |
0/21 (0) | - |
| So et al [66] | Tokyo, Japan | Case series | Single center | 64(47–73) | Mar 2020 | 7 | - | - | Pulse therapy: MTP 1000 or 500 mg/d for three days, followed by 1 mg/kg/d, then tapered off | 0/7 (0) | - |
| Lee et al [67] | Daegu/Gyeongsangbuk-do, Korea | Retrospective cohort study | Multicenter | 72(68–79) | Feb 18–4 March 2020 | 98 | - | - | No information | 15/28 (53.6) | - |
ARDS = acute respiratory distress syndrome; DEX = dexamethasone; HYC = hydrocortisone; M = mean; MTP = methylprednisolone; PRED: prednisolone; SD = standard deviation
aAge was reported as median (lower quartile-upper quartile) unless otherwise indicated.
bOnly for original studies included in the meta-analysis to determine mortality estimates of ARDS in COVID-19 (7 = good studies; 5–6 = fair studies; 0–4 = poor studies