Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis

  1. Haytham Tlayjeh
  2. Olaa H. Mhish
  3. Mushira A. Enani
  4. Alya Alruwaili
  5. Rana Tleyjeh
  6. Lukman Thalib
  7. Leslie Hassett
  8. Yaseen M. Arabi
  9. Tarek Kashour
  10. Imad M. Tleyjeh

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Abstract

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  1. Version published to 10.1016/j.jiph.2020.09.008
  2. ScreenIT

    SciScore for 10.1101/2020.08.13.20174201: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationQuality Assessment: Four reviewers (ME, AA, OM, HT) independently assessed the risk of bias for each study using the (RoB 2) of the Cochrane risk-of-bias tool for randomized trials and the ROBINS-I (“Risk Of Bias In Non-randomized Studies of Interventions”) for observational studies [16].
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    In addition, we searched Google Scholar and the references of eligible studies and review articles.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    Quality Assessment: Four reviewers (ME, AA, OM, HT) independently assessed the risk of bias for each study using the (RoB 2) of the Cochrane risk-of-bias tool for randomized trials and the ROBINS-I (“Risk Of Bias In Non-randomized Studies of Interventions”) for observational studies [16].
    Quality Assessment
    suggested: (Image and Data Quality Assessment Ontology, RRID:SCR_010343)
    Cochrane
    suggested: (Cochrane Library, RRID:SCR_013000)
    All analyses were conducted using Stata version 16 statistical software (StataCorp, College Station, Texas).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: Our meta-analysis has several strengths. Firstly, published, and unpublished studies were included, which reduces publication bias. We also employed rigorous methodologies. We excluded studies that were prone to significant confounding because they did not report adjusted odds or hazard ratios. We also examined mortality and other clinical outcomes separately and performed sensitivity analyses to explore sources of between studies heterogeneity. However, our study has several limitations; all our included studies except one were observational studies which are prone to different biases; including confounding by indication, survivor (immortal time) bias and residual confounding. Our group and others have shown that survivor bias, which occurs because patients who live longer are more likely to receive treatment than those who die early, could change associations from benefit to harm [8, 17, 63]. Only one observational study has adjusted for survivor bias [46] and in this single study, CST was associated with a higher mortality in both severe and critical subgroups. Moreover, as with all observational studies, residual confounding could inflict any observed association [64] even with appropriate adjustment or propensity score matching. Nevertheless, the direction of these different biases is supposed to be in favor of corticosteroids efficacy, which was not observed in our analysis. Conclusions: We found in this systematic review and meta-analysis tha...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.08.13.20174201 on medRxiv