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146: Controversial Role of Corticosteroids on Mortality in COVID-19: Systematic Review and Meta-Analysis

INTRODUCTION: Corticosteroid use in COVID 19 patients has been a much debated topic, and there has been no clear evidence so far supporting it as an effective medication to reduce the inflammatory response and improve mortality rates We aim to review the data on mortality benefits observed with the use of corticosteroids in COVID-19 METHODS: A comprehensive literature search was conducted across the three largest COVID 19 database provided by WHO, CDC, and LitCovid PubMed Database from inception to July 19th, 2020 We included studies that compared the risk of death among patients with and without use of systemic corticosteroids We then summarized risk estimates into two random-effect metaanalyses;one with randomized controlled trials and another one with observational studies We analyzed data in Review Manager Software, version 5 2 (Nordic Cochrane Center, Copenhagen, Denmark), to evaluate combined odds ratio (OR) for RCTs and observational studies with respective 95% confidence intervals (CI) using a random-effects model RESULTS: Out of total 23 articles, 11 studied were included in final meta-analysis Among these, 3889 patients were treated with corticosteroids and 5954 were not The metaanalysis of five clinical trials/prospective studies indicated that administration of corticosteroid significantly reduces the mortality compared to the no corticosteroid use (OR 0 52, 95% CI 0 31-0 87, p-value 0 01;I2=76%) However the meta-analysis of six retrospective observational studies/case series showed summed odds ratio of 2 69;95% CI 0 66 to 10 99, p-value 0 17, I2=94%, suggesting increased risk of mortality with use of systemic steroids CONCLUSIONS: We observed mortality benefits from metaanalysis on available RCTs On the contrary, a meta-analysis of observational studies suggested a higher risk of death in similar patients;however, the grade of confidence in this subgroup's results is lower due to inherent methodological limitations