Differential effect of corticosteroid treatment on Influenza, SARS, MERS, and SARS-CoV-2 patients: A meta-analysis and systematic review

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1. 

   ScreenIT

   Mar 30, 2021

   SciScore for 10.1101/2021.03.22.21254104: (What is this?)

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

   Table 1: Rigor

   Institutional Review Board Statement	not detected.
   Randomization	not detected.
   Blinding	not detected.
   Power Analysis	not detected.
   Sex as a biological variable	Authors were asked to extract information on authors, title, year of publication, number of patient in the treatment arm, number of patient in the control arm, a corticosteroid used, placebo-control or not, type of study, the mortality rate (control/corticosteroid), secondary infection rate (bacterial), secondary infection rate (viral), male/female (% of the total patient), male/female (% of control/corticosteroid group), the mean age of the total patient, mean age of the dead patient, length of hospital stay, length of ICU stay, dead patients …

   SciScore for 10.1101/2021.03.22.21254104: (What is this?)

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

   Table 1: Rigor

   Institutional Review Board Statement	not detected.
   Randomization	not detected.
   Blinding	not detected.
   Power Analysis	not detected.
   Sex as a biological variable	Authors were asked to extract information on authors, title, year of publication, number of patient in the treatment arm, number of patient in the control arm, a corticosteroid used, placebo-control or not, type of study, the mortality rate (control/corticosteroid), secondary infection rate (bacterial), secondary infection rate (viral), male/female (% of the total patient), male/female (% of control/corticosteroid group), the mean age of the total patient, mean age of the dead patient, length of hospital stay, length of ICU stay, dead patients underlying health conditions, comorbidities of patients, name of viral infection, length of mechanical ventilation, Viral/RNA clearance time/viral shedding duration, and the median daily dosage of corticosteroid.

   Table 2: Resources

   Software and Algorithms
   Sentences	Resources
   2.1 Articles search strategies: A literature search was performed in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Google Scholar, and Web of Science records using keywords such as: “corticosteroid” or “viral infection” or “patients” or “control study”.	PubMed suggested: (PubMed, RRID:SCR_004846) Cochrane Central Register of Controlled Trials suggested: (Cochrane Central Register of Controlled Trials, RRID:SCR_006576) Medline suggested: (MEDLINE, RRID:SCR_002185) Google Scholar suggested: (Google Scholar, RRID:SCR_008878)
   2.6 Statistical Analysis: All statistical analysis was performed by using statistical software STATA 13 [29].	STATA suggested: (Stata, RRID:SCR_012763)

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   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).

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   Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

   Regardless of these outcomes, our study has some limitations. First, the strength of the conclusion made by the studies before the COVID-19 pandemic is not so strong because there was only one RCT study in our analysis, all studies that we include in this review are observational studies having many lurking variables. Now that RCTs showed a beneficial effect of corticosteroid, the deleterious effect of it from the cohort studies becomes questionable. Second, we could not separate patients who obtained corticosteroids for underlying disease (e.g., COPD). We also could not perform subgroup analysis based on doses of steroid received, early or late steroid use, or other factors. Data on dose, duration, timing, types, and rationales of corticosteroid administration and the timing and duration of antiviral therapy were very insufficient. Before starting this review one of the goals was to see what happens if corticosteroid is applied after cytokine storm vs before cytokine storm but due to data limitation, it was not possible to analyze and opens a new avenue to investigate in the future. Third, the baseline criteria of the patients can control outcomes and differences among the studies included in our analysis. For example, an association had been observed between fewer secondary infections and younger age and fewer underlying diseases.

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   Results from TrialIdentifier: No clinical trial numbers were referenced.

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

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

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   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.

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   Version published to 10.1101/2021.03.22.21254104v1 on medRxiv

   Mar 26, 2021