Background Corticosteroids are commonly used as adjuvant therapy for acute respiratory distress syndrome by many clinicians because of their perceived anti-inflammatory effects. However, for patients with severe viral pneumonia, the corticosteroid treatment is highly controversial. Objectives The purpose of this review is to systematically evaluate the effect and potential mechanism of corticosteroid administration in pandemic viral pneumonia. Sources We comprehensively searched all manuscripts on corticosteroid therapy for influenza, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and SARS coronavirus 2 (SARS-CoV-2) viral pneumonia from the PubMed, EMBASE, Web of Science and Cochrane Library databases. Content We systematically summarized the effects of corticosteroid therapy for pandemic viral pneumonia and the potential mechanism of action for corticosteroids in coronavirus disease 2019 (COVID-19). Implications Observational studies showed that corticosteroid treatment was associated with increased mortality and nosocomial infections for influenza and delayed virus clearance for SARS-CoV and MERS-CoV. Limited data on corticosteroid therapy for COVID-19 were reported. Corticosteroids were used in about a fifth of patients (670/2995, 22.4%). Although clinical observational studies reported the improvement in symptoms and oxygenation for individuals with severe COVID-19 who received corticosteroid therapy, case fatality rate in the corticosteroid group was significantly higher than that in the non-corticosteroid group (69/443, 15.6% versus 56/1310, 4.3%). Compared individuals with non-severe disease, those with severe disease were more likely to receive corticosteroid therapy (201/382, 52.6% versus 201/1310, 15.3%). Although there is no evidence that corticosteroid therapy reduces mortality in people with COVID-19, some improvements in clinical symptoms and oxygenation were reported in some clinical observational studies. Excessive inflammatory response and lymphopenia might be critical factors associated with severity of and mortality from COVID-19. Sufficiently powered randomized controlled trials with rigorous inclusion/exclusion criteria and standardized dose and duration of corticosteroids are needed to verify the effectiveness and safety of corticosteroid therapy.
【저자키워드】 Corticosteroid, COVID-19, Influenza, SARS, MERS, 【초록키워드】 Randomized controlled trial, coronavirus disease, SARS-CoV-2, Anti-inflammatory effects, pandemic, therapy, Mortality, severe COVID-19, SARS-CoV, severity, Symptom, MERS-CoV, observational studies, observational study, lymphopenia, improvement, Viral pneumonia, Patient, Effectiveness, Nosocomial infection, SARS Coronavirus, severe viral pneumonia, disease, Critical, acute respiratory distress, Evidence, Inflammatory response, administration, dose, severe disease, Oxygenation, criteria, Middle East, acute respiratory syndrome, Factor, Web of Science, potential mechanism, clinician, clinical symptom, virus clearance, individual, syndrome, Fatality rate, Cochrane Library, increased mortality, manuscript, content, corticosteroid therapy, corticosteroid treatment, Effect, objective, reported, were used, searched, significantly higher, reduce, Source, evaluate the effect, receive, Limited, people with COVID-19, 【제목키워드】 administration,