• Edison J Cano, Fonseca FuentesXavierXDivision of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN., Corsini CampioliCristinaCDivision of Infectious Disease, Mayo Clinic, Rochester, MN., John C O'Horo, Abu SalehOmarODivision of Infectious Disease, Mayo Clinic, Rochester, MN., Yewande Odeyemi, Hemang Yadav, and Zelalem Temesgen.
• Division of Infectious Disease, Mayo Clinic, Rochester, MN. Electronic address: canocevallos.edison@mayo.edu.
• Chest. 2021 Mar 1; 159 (3): 101910401019-1040.

BackgroundSince its appearance in late 2019, infections caused by severe acute respiratory syndrome coronavirus 2 have created unprecedented challenges for health systems worldwide. Multiple therapeutic options have been explored, including corticosteroids. Preliminary results of corticosteroids in coronavirus disease 2019 (COVID-19) are encouraging; however, the role of corticosteroids remains controversial.Research QuestionWhat is the impact of corticosteroids in mortality, ICU admission, mechanical ventilation, and viral shedding in COVID-19 patients?Study Design And MethodsWe conducted a systematic review of literature on corticosteroids and COVID-19 in major databases (PubMed, MEDLINE, and EMBASE) of published literature through July 22, 2020, that report outcomes of interest in COVID-19 patients receiving corticosteroids with a comparative group.ResultsA total of 73 studies with 21,350 COVID-19 patients were identified. Corticosteroid use was reported widely in mechanically ventilated patients (35.3%), ICU patients (51.3%), and severe COVID-19 patients (40%). Corticosteroids showed mortality benefit in severelly ill COVID-19 patients (OR, 0.65; 95% CI, 0.51-0.83; P = .0006); however, no beneficial or harmful effects were noted among high-dose or low-dose corticosteroid regimens. Emerging evidence shows that low-dose corticosteroids do not have a significant impact in the duration of SARS-CoV-2 viral shedding. The analysis was limited by highly heterogeneous literature for high-dose and low-dose corticosteroids regimens.InterpretationOur results showed evidence of mortality benefit in severely ill COVID-19 patients treated with corticosteroids. Corticosteroids are used widely in COVID-19 patients worldwide, and a rapidly developing global pandemic warrants further high-quality clinical trials to define the most beneficial timing and dosing for corticosteroids.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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