Efficacy of corticosteroid in patients with COVID‐19: A multi‐center retrospective study and meta‐analysis

To evaluate the efficacy of corticosteroids on coronavirus disease 2019 (COVID‐19) patients with different levels of disease severity. In our multicenter study, 543 patients with confirmed COVID‐19 were classified as non‐severe group and severe group, and then were compared respectively for all‐cause mortality and length of hospital stay between those who received corticosteroids and not. By searching in PubMed, Web of Science, Embase, and CNKI, we identified 13 retrospective studies and 6 random control trials eligible for criteria of inclusion, and conducted comprehensive meta‐analyses assessing the impacts of corticosteroids on mortality, length of stay, duration of RNA clearance and duration of fever. Our multicenter study demonstrated that low‐dose corticosteroids can reduce mortality in the multivariable Cox regression analysis for severe patients (p = .03), while presented no influence in univariable analysis for non‐severe patients (p = .14). From multivariable analyses, patients with corticosteroids in non‐severe group had longer duration of hospitalization (p = .003), but did not in severe group (p = .18). Moreover, for severe patients, corticosteroids can evidently shorten duration of fever. The same results were summarized in the meta‐analyses supplemented with the result that corticosteroids delayed viral clearing in non‐severe patients. Corticosteroids should be considered based on patient's condition. For patients with non‐severe COVID‐19, corticosteroid was not recommended as a routine therapeutic initiative as that presented prolonged duration of hospitalization and delayed viral clearing, as well as no positive impact on prognosis. While low‐dose corticosteroids may benefit patients with severe COVID‐19 for it can manifestly lower risk of death and improve the clinical status to some extent.