(1) Background: The use of corticosteroids in critical coronavirus infections, including severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), or Coronavirus disease 2019 (COVID-19), has been controversial. However, a meta-analysis on the efficacy of steroids in treating these coronavirus infections is lacking. (2) Purpose: We assessed a methodological criticism on the quality of previous published meta-analyses and the risk of misleading conclusions with important therapeutic consequences. We also examined the evidence of the efficacy of corticosteroids in reducing mortality in SARS, MERS and COVID-19. (3) Methods: PubMed, MEDLINE, Embase, and Web of Science were used to identify studies published until 25 April 2020, that reported associations between steroid use and mortality in treating SARS/MERS/COVID-19. Two investigators screened and extracted data independently. Searches were restricted to studies on humans, and articles that did not report the exact number of patients in each group or data on mortality were excluded. We calculated odds ratios (ORs) or hazard ratios (HRs) under the fixed- and random-effect model. (4) Results: Eight articles (4051 patients) were eligible for inclusion. Among these selected studies, 3416 patients were diagnosed with SARS, 360 patients with MERS, and 275 with COVID-19; 60.3% patients were administered steroids. The meta-analyses including all studies showed no differences overall in terms of mortality (OR 1.152, 95% CI 0.631–2.101 in the random effects model, p = 0.645). However, this conclusion might be biased, because, in some studies, the patients in the steroid group had more severe symptoms than those in the control group. In contrast, when the meta-analysis was performed restricting only to studies that used appropriate adjustment (e.g., time, disease severity), there was a significant difference between the two groups (HR 0.378, 95% CI 0.221–0.646 in the random effects model, p < 0.0001). Although there was no difference in mortality when steroids were used in severe cases, there was a difference among the group with more underlying diseases (OR 3.133, 95% CI 1.670–5.877, p < 0.001). (5) Conclusions: To our knowledge, this study is the first comprehensive systematic review and meta-analysis providing the most accurate evidence on the effect of steroids in coronavirus infections. If not contraindicated, and in the absence of side effects, the use of steroids should be considered in coronavirus infection including COVID-19.
【저자키워드】 coronavirus, Corticosteroids, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), 【초록키워드】 Corticosteroid, COVID-19, Meta-analysis, Coronavirus infection, Coronavirus disease 2019, Efficacy, Mortality, knowledge, disease severity, systematic review, risk, underlying disease, MERS, Steroids, Coronavirus infections, Consequences, humans, therapeutic, Patient, severe cases, Side effects, respiratory, Critical, patients, association, Evidence, Odds ratio, Middle East, steroid, acute respiratory syndrome, Web of Science, significant difference, control group, 95% CI, hazard ratio, no difference, investigator, reducing mortality, article, random effect, Administered, selected, identify, examined, reported, the patient, diagnosed, was performed, screened, calculated, were used, absence, two group, fixed, severe symptom, methodological, eligible, for inclusion, had more, HRs, use of corticosteroid, use of steroid, were excluded, 【제목키워드】 review, MERS,