The quality of evidence is downgraded by inconsistency (variability in results).
A Cochrane review [Abstract] 1 included 61 studies with a total of 12 192 subjects, of which 6 included only children, 2 included children and adults, and the remaining studies included only adults.
Corticosteroids reduced 28-day mortality (RR 0.92, 95% CI 0.84 to 0.99; 50 studies, n=11 233) and hospital mortality (RR 0.90, 95% CI 0.82 to 0.99; 26 studies, n=8 183), but there was no statistically significant reduction in long-term mortality (RR 0.97, 95% CI 0.91 to 1.03; 7 studies, n=6 236) compared to placebo or usual care. Corticosteroids reduced length of intensive care unit (ICU) stay (MD -1.07 days, 95% CI -1.95 to -0.19; 21 studies, n=7 612) and length of hospital stay (MD -1.63 days, 95% CI -2.93 to -0.33; 22 studies, n=8 795, statistical heterogeneity I2 =59%) for all participants.
Corticosteroids increased the risk of muscle weakness (RR 1.21, 95% CI 1.01 to 1.44; 6 studies, n=6 145), hypernatraemia, and hyperglycaemia. There was no statistically significant difference in the risk of superinfection (RR 1.06, 95% CI 0.95 to 1.19; 25 studies, n=5 356). There was no difference in gastroduodenal bleeding, stroke, cardiac events, or neuropsychiatric events.
Primary/Secondary Keywords