Table 2.
Summary of findings
| Steroid compared to no steroid: All patients for COVID-19 Date August 3, 2020 | ||||||
|---|---|---|---|---|---|---|
| Patient or population: COVID-19 Date August 3, 2020 | ||||||
| Setting: | ||||||
| Intervention: Steroid | ||||||
| Comparison: No steroid: All patients | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (grade) | Comments | |
| Risk with no steroid: All patients | Risk with steroid | |||||
| Severe and critical: Mortality | 296 per 1000 | 246 per 1000 (225-269) | RR 0.83 (0.76-0.91) | 5787 (6 observational studies) | ⨁⨁⨁◯ Moderatea,b | |
| Severe and critical: Requirement of MV | 431 per 1000 | 254 per 1000 (220-297) | RR 0.59 (0.51-0.69) | 1511 (6 observational studies) | ⨁⨁◯◯ LOWa | |
| Severe and critical: Requirement of ICU | 339 per 1000 | 210 per 1000 (153292) | RR 0.62 (0.450.86) | 386 (2 observational studies) | ⨁⨁◯◯ Low | |
| Mild and moderate: Mortality | 138 per 1000 | 175 per 1000 (138-221) | RR 1.27 (1.00-1.61) | 1566 (2 observational studies) | ⨁⨁◯◯ Low | |
| Mild and moderate: Duration of hospital stay | The mean mild and moderat: Duration of hospital stay was 0 | MD 2.63 higher (1 higher to 4.26 higher) | - | 101 (2 observational studies) | ⨁⨁◯◯ Low | |
| Mild and moderate: Time to virological cure | The mean mild and moderate: time to virological cure was 0 | MD 0.89 higher (1.05 lower to 2.84 higher) | - | 101 (2 observational studies) | ⨁⨁◯◯ Low | |
aRisk of Bias: As the studies included is mix of randomized and nonrandomized studies. RCT with high risk of bias at the level of allocation a concealment and blinding and low risk of bias with nonrandomized studies with certain limitations. We have downgraded at serious level considering these factors, bImprecision: The upper limit of the 95% CI is 0.76-0.91. The minimum expected risk reduction in mortality is 9%. We have not downgraded considering the fast spread of this condition. Grade working group grades of evidence. High certainty: We are very confident that the true effect lies close to that of the estimate of the effect, Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different, Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect, Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI=Confidence interval, RR=Risk ratio, MD=Mean difference, RCT=Randomized controlled trial