Table 1. . Summary of findings, corticosteroid regimens compared with standard of care/adjuvant therapies for the management of hospitalized COVID-19 patients.
| Outcomes | Relative effect (95% CI) | Anticipated absolute effects (95% CI)† | Patients, n (studies, n) | Quality of evidence (GRADE) | ||
|---|---|---|---|---|---|---|
| Risk without corticosteroids | Risk with corticosteroids | Risk difference (95% CI) | ||||
| Time to negative test conversion | – | The mean time in the control group was 15 days | – |
MD 1.80 more days (0.48 more to 3.11 more) |
2,785 (1 RCT, 18 OSs) |
⊕◯◯◯ Very low‡,§,¶ |
| Length of stay | – | The mean time in the control group was 16 days | – |
MD 1.60 more days (0.20 fewer to 3.40 more) |
10,454 (3 RCTs, 27 OSs) |
⊕◯◯◯ Very low‡,§,¶,# |
| ICU length of stay | – | The mean time in the control group was 12 days | – |
MD 0.01 fewer days (3.50 fewer to 3.47 more) |
3,233 (1 RCT, 6 OSs) |
⊕◯◯◯ Very low‡,§,¶,# |
| Incidence of ICU admission |
OR 0.87 (0.52–1.47) |
121 per 1000 |
107 per 1000 (67–168) |
14 fewer per 1000 (54 fewer to 47 more) |
10,391 (2 RCTs, 15 OSs) |
⊕◯◯◯ Very low‡,§,¶,# |
| Mortality |
OR 1.00 (0.84–1.20) |
235 per 1000 |
235 per 1000 (205–269) |
0 fewer per 1000 (30 fewer to 34 more) |
40,623 (10 RCTs, 76 OSs) |
⊕◯◯◯ Very low‡,§,¶,# |
| Incidence of mechanical ventilation |
OR 1.19 (0.81–1.76) |
139 per 1000 |
161 per 1000 (116–221) |
22 more per 1000 (23 fewer to 82 more) |
20,453 (4 RCTs, 33 OSs) |
⊕◯◯◯ Very low‡,§,¶,# |
| Length of mechanical ventilation | – | The mean time in the control group was 6 days | – |
MD 1.71 fewer days (2.54 fewer to 0.88 fewer) |
977 (1 RCT, 6 OSs) |
⊕◯◯◯ Very low‡,§ |
| Incidence of adverse events |
OR 1.89 (0.98–3.63) |
362 per 1000 |
517 per 1000 (512–828) |
155 more per 1000 (5 fewer to 311 more) |
3,409 (1 RCT, 8 OSs) |
⊕◯◯◯ Very low‡,§,# |
| Incidence of severe adverse events |
OR 0.87 (0.47–1.62) |
57 per 1000 |
50 per 1000 (27–89) |
7 fewer per 1000 (30 fewer to 32 more) |
1,142 (4 RCTs, 2 OSs) |
⊕⊕⊕◯ Moderate# |
| Incidence of hyperglycemia |
OR 2.45 (1.08–5.56) |
99 per 1000 |
212 per 1000 (106–379) |
113 more per 1000 (7 more to 280 more) |
2,898 (3 RCTs, 8 OSs) |
⊕⊕◯◯ Low‡,§,†† |
| Incidence of nosocomial infections |
OR 1.06 (0.82–1.37) |
150 per 1000 |
158 per 1000 (126–195) |
8 more per 1000 (24 fewer to 45 more) |
9,483 (4 RCTs, 23 OSs) |
⊕◯◯◯ Very low‡,§,# |
Bold values represent the most important metrics.
GRADE Working Group quality of evidence rating [70].
High quality: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: 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 quality: Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.
Very low quality: 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).
Quality of study was rated as low prior to downgrading or upgrading as a majority of the included studies were observational studies.
Downgraded due to study limitations; a majority of included studies were rated as having serious or critical risk of bias according to ROBINS-I and/or RoB2.
Downgraded due to inconsistency; significant and severe heterogeneity was observed in the analysis.
Downgraded due to imprecision; confidence intervals could not rule out the possibility of no effect (crosses null).
Upgraded due to a large magnitude of effect.
GRADE: Grading of recommendations, assessment, development and evaluation; MD: Mean difference; OR: Odds ratio; OS: Observational study; RCT: Randomized controlled trial.