Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury
The LancetPublished 1 February 2020Open access
Clark D Russell, Jonathan Millar, J. Kenneth Baillie
Citations2,062
SJR quartileQ1
SJR score12.11
SNIP22.72
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
The 2019 novel coronavirus (2019-nCoV) outbreak is a major challenge for clinicians as little data is available that describe the disease pathogenesis, and no pharmacological therapies of proven efficacy yet exist, so understanding the evidence for harm or benefit from corticosteroids in 2019-n coV is of immediate clinical importance.
Keywords
Medicine
The LancetClinical features of patients infected with 2019 novel coronavirus in Wuhan, China
51,817 Citations2020Chaolin Huang, Yeming Wang +27 more
The epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of patients with laboratory-confirmed 2019-nCoV infection in Wuhan, China, were reported.
The LancetEpidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study
22,688 Citations2020Nanshan Chen, Min Zhou +12 more
Characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia, and further investigation is needed to explore the applicability of the Mu LBSTA scores in predicting the risk of mortality in 2019-nCoV infection.
The LancetA familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster
9,560 Citations2020Jasper Fuk‐Woo Chan, Shuofeng Yuan +19 more
The findings are consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions.
The LancetACUTE RESPIRATORY DISTRESS IN ADULTS
4,203 Citations1967D G Ashbaugh, D. Boyd Bigelow +2 more
Positive end-expiratory pressure was most helpful in combating atelectasis and hypoxaemia and Corticosteroids appeared to have value in the treatment of patients with fat-embolism and possibly viral pneumonia.
The LancetClinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study
2,448 Citations2003Malik Peiris, Chung‐Ming Chu +15 more
The consistent clinical progression, shifting radiological infiltrates, and an inverted V viral-load profile suggest that worsening in week 2 is unrelated to uncontrolled viral replication but may be related to immunopathological damage.
The Lancet Infectious DiseasesEpidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study
1,466 Citations2013Abdullah M. Assiri, Jaffar A. Al‐Tawfiq +11 more
Disease caused by MERS-CoV presents with a wide range of clinical manifestations and is associated with substantial mortality in admitted patients who have medical comorbidities, and major gaps in knowledge of the epidemiology, community prevalence, and clinical spectrum of infection and disease need urgent definition.
PLoS MedicineSARS: Systematic Review of Treatment Effects
1,256 Citations2006Lauren J. Stockman, Richard Bellamy +1 more
It was not possible to determine whether treatments benefited patients during the SARS outbreak, but clinical trials should be designed to validate a standard protocol for dosage and timing and to accrue data in real time during future outbreaks to monitor specific adverse effects and help inform treatment.
American Journal of Respiratory and Critical Care MedicineCorticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome
1,206 Citations2017Yaseen M. Arabi, Yasser Mandourah +27 more
Corticosteroid therapy in patients with MERS was not associated with a difference in mortality after adjustment for time‐varying confounders but was associated with delayed MERS coronavirus RNA clearance.
The LancetLung pathology of fatal severe acute respiratory syndrome
1,115 Citations2003John M. Nicholls, Leo L. M. Poon +14 more
The presence of haemophagocytosis supports the contention that cytokine dysregulation may account, at least partly, for the severity of the clinical disease.
New England Journal of MedicineAdjunctive Glucocorticoid Therapy in Patients with Septic Shock
1,001 Citations2018Balasubramanian Venkatesh, Simon Finfer +16 more
Among patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90‐day mortality than placebo and there were no significant between‐group differences with respect to mortality at 28 days, the rate of recurrence of shock, the number of days alive and out of the ICU, the Recurrence of mechanical ventilation.
New England Journal of MedicineHydrocortisone plus Fludrocortisone for Adults with Septic Shock
891 Citations2018Djillali Annane, Alain Renault +35 more
In this trial involving patients with septic shock, 90‐day all‐cause mortality was lower among those who received hydrocortisone plus fludrocort isone or with drotrecogin alfa (activated), the combination of the three drugs, or their respective placebos.
Journal of Clinical VirologyEffects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients
676 Citations2004Nelson Lee, K.C. Allen Chan +12 more
Findings suggested “early” corticosteroid treatment was associated with a higher subsequent plasma viral load in previously healthy SARS patients.
New England Journal of MedicineMiddle East Respiratory Syndrome
511 Citations2017Yaseen M. Arabi, Hanan H. Balkhy +14 more
The Middle East respiratory syndrome is caused by a coronavirus that was first identified in Saudi Arabia in 2012 and continues to occur in the Middle East and elsewhere.
Critical CareThe effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis
399 Citations2019Yuenan Ni, Guo Chen +3 more
In patients with influenza pneumonia, corticosteroid use is associated with higher mortality, and ten trials involving 6548 patients were pooled in the final analysis.
Annals of Internal MedicineThe Epidemiology of Severe Acute Respiratory Syndrome in the 2003 Hong Kong Epidemic: An Analysis of All 1755 Patients
356 Citations2004GM Leung, Anthony J. Hedley +17 more
An epidemiologic analysis of the 2003 outbreak of severe acute respiratory syndrome in Hong Kong found that most cases clustered in hospitals and residential buildings, suggesting that SARS had low transmissibility, except in settings of intimate contact or clinically significant environmental contamination.
New England Journal of MedicineA Multicenter, Randomized, Controlled Trial of Dexamethasone for Bronchiolitis
287 Citations2007Howard M. Corneli, Joseph J. Zorc +20 more
In infants with acute moderate-to-severe bronchiolitis who were treated in the emergency department, a single dose of 1 mg of oral dexamethasone per kilogram did not significantly alter the rate of hospital admission, the respiratory status after 4 hours of observation, or later outcomes.
Clinical ChemistryEarly Enhanced Expression of Interferon-Inducible Protein-10 (CXCL-10) and Other Chemokines Predicts Adverse Outcome in Severe Acute Respiratory Syndrome
235 Citations2005Nelson L.S. Tang, Paul K.S. Chan +7 more
Increased plasma IP-10 during the first week of SARS symptoms is an independent predictor of outcome, and chemokine activation may be an early event in SARS, and an exaggerated host response may produce complications.
Cochrane Database of Systematic ReviewsPharmacological agents for adults with acute respiratory distress syndrome
200 Citations2019Sharon R Lewis, Michael Pritchard +2 more
Evaluating the effectiveness of pharmacological agents in adults with ARDS on mortality, mechanical ventilation, and fitness to return to work at 12 months found that ventilator-free days up to day 28 (VFD) may be improved with corticosteroids.
Critical Care MedicineHemodynamic impact of a positive end-expiratory pressure setting in acute respiratory distress syndrome: Importance of the volume status*
179 Citations2010Emilie Fougères, Jean–Louis Teboul +4 more
In acute respiratory distress syndrome patients, a positive end-expiratory pressure increase with limited tidal volume and plateau pressure reduced cardiac output by increasing the right ventricular afterload and restored cardiacoutput by reducing the transpulmonary pressure difference and the pulmonary vascular resistance.
Clinical Infectious DiseasesFactors Associated with Psychosis among Patients with Severe Acute Respiratory Syndrome: A Case-Control Study
140 Citations2004D. T. S. Lee, Yun Kwok Wing +6 more
It is suggested that steroid toxicity, personal vulnerability, and, probably, psychosocial stressors jointly contributed to the development of psychosis in patients with SARS.
Archives of Internal MedicineUse of Corticosteroids in Treating Infectious Diseases
118 Citations2008Steven McGee
It is concluded that corticosteroids are beneficial and safe for a wide variety of infections, although courses longer than 3 weeks should be withheld from patients with concomitant human immunodeficiency virus infection and low CD4 counts.
The Journal of Infectious DiseasesAge- and Sex-Specific Mortality Associated With the 1918–1919 Influenza Pandemic in Kentucky
89 Citations2012Cécile Viboud, Jana Eisenstein +4 more
The atypical age mortality patterns of the 1918–1919 pandemic cannot be explained by military crowding, war-related factors, or prior immunity alone and likely result from a combination of unknown factors.
PubMed[Factors of avascular necrosis of femoral head and osteoporosis in SARS patients' convalescence].
61 Citations2004Yuming Li, Shixin Wang +9 more
The incidence rates of avascular necrosis of femoral head and of osteoporosis were higher in convalescent SARS patients than in general population and the influencing factors of bone density included age, dosage summation, and length of ictus therapy.
PubMed[Glucocorticoid-induced diabetes in severe acute respiratory syndrome: the impact of high dosage and duration of methylprednisolone therapy].
57 Citations2004Jianzhong Xiao, Li Ma +6 more
Over-dose administration of methylprednisolone in SARS patients leads to a high frequency of diabetes, and decreasing the daily maximal dosage may be beneficial to the reduction of corticosteroid-induced of diabetes.
CHEST JournalThe Effect of Steroid Use in Hospitalized Adults With Respiratory Syncytial Virus-Related Illness
56 Citations2011F. Eun-Hyung Lee, Edward E. Walsh +1 more
There were no serious adverse events related to steroids and no significant differences in peak viral load, duration of RSV shedding, nasal cytokines, or lymphocyte subsets in patients treated with steroids and patients untreated with steroids.
PubMedDynamic changes in blood cytokine levels as clinical indicators in severe acute respiratory syndrome.
54 Citations2003
Most proinflammatory cytokines and TGF-beta 1 were elevated during the early phase of SARS, which may be associated with lung infiltration and proliferation.