The DOI matches its Crossref record; 30 of the 30 references it cites were found in a registry or an index; none of the 8 sources its claims cite is checked for support yet.
Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis
Open accessAbstract
Importance: Effective therapies for patients with coronavirus disease 2019 (COVID-19) are needed, and clinical trial data have demonstrated that low-dose dexamethasone reduced mortality in hospitalized patients with COVID-19 who required respiratory support. Objective: To estimate the association between administration of corticosteroids compared with usual care or placebo and 28-day all-cause mortality. Design, Setting, and Participants: Prospective meta-analysis that pooled data from 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19. The trials were conducted in 12 countries from February 26, 2020, to June 9, 2020, and the date of final follow-up was July 6, 2020. Pooled data were aggregated from the individual trials, overall, and in predefined subgroups. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I2 statistic. The primary analysis was an inverse variance-weighted fixed-effect meta-analysis of overall mortality, with the association between the intervention and mortality quantified using odds ratios (ORs). Random-effects meta-analyses also were conducted (with the Paule-Mandel estimate of heterogeneity and the Hartung-Knapp adjustment) and an inverse variance-weighted fixed-effect analysis using risk ratios. Exposures: Patients had been randomized to receive systemic dexamethasone, hydrocortisone, or methylprednisolone (678 patients) or to receive usual care or placebo (1025 patients). Main Outcomes and Measures: The primary outcome measure was all-cause mortality at 28 days after randomization. A secondary outcome was investigator-defined serious adverse events. Results: A total of 1703 patients (median age, 60 years [interquartile range, 52-68 years]; 488 [29%] women) were included in the analysis. Risk of bias was assessed as "low" for 6 of the 7 mortality results and as "some concerns" in 1 trial because of the randomization method. Five trials reported mortality at 28 days, 1 trial at 21 days, and 1 trial at 30 days. There were 222 deaths among the 678 patients randomized to corticosteroids and 425 deaths among the 1025 patients randomized to usual care or placebo (summary OR, 0.66 [95% CI, 0.53-0.82]; P < .001 based on a fixed-effect meta-analysis). There was little inconsistency between the trial results (I2 = 15.6%; P = .31 for heterogeneity) and the summary OR was 0.70 (95% CI, 0.48-1.01; P = .053) based on the random-effects meta-analysis. The fixed-effect summary OR for the association with mortality was 0.64 (95% CI, 0.50-0.82; P < .001) for dexamethasone compared with usual care or placebo (3 trials, 1282 patients, and 527 deaths), the OR was 0.69 (95% CI, 0.43-1.12; P = .13) for hydrocortisone (3 trials, 374 patients, and 94 deaths), and the OR was 0.91 (95% CI, 0.29-2.87; P = .87) for methylprednisolone (1 trial, 47 patients, and 26 deaths). Among the 6 trials that reported serious adverse events, 64 events occurred among 354 patients randomized to corticosteroids and 80 events occurred among 342 patients randomized to usual care or placebo. Conclusions and Relevance: In this prospective meta-analysis of clinical trials of critically ill patients with COVID-19, administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality.
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Claims the paper makes
54 Own result · 33 Own method · 10 Own interpretation · 8 Not checked yet · 6 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were 222 deaths among 678 patients randomized to corticosteroids and 425 deaths among 1025 patients randomized to usual care or placebo.”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality
plainn = 678- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the OR was 0.64 (95% CI, 0.49-0.83) among 1111 patients who were sympto- matic for more than 7 days prior to randomization”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups
plaincorrelationaln = 1,111- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For the association be- tween corticosteroids and mortality, the OR was 1.05 (95% CI, 0.65-1.69) among patients who were receiving vasoactive agents at randomization (an absolute risk of 48% for cortico- steroids vs 47% for usual care or placebo)”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups
plainn = 401- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the OR was 0.55 (95% CI, 0.34-0.88) among patients who were not receiving vasoactive agents at randomization (an absolute risk of 24% for corticosteroids vs 37% for usual care or placebo).”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups
plaincorrelationaln = 401- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“49.8 76/169 74/158 Yes (I 2 = 0%) 1.05 (0.65-1.69)”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“which was consistent with the corresponding result based on patients in the RECOVERY trial who were receiving invasive mechanical ventilation at randomization (OR, 0.59 [95% CI, 0.44-0.78]).”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Age, y 42.7 72/338 141/483 ≤60 (I 2 = 0%) 0.67 (0.48-0.94)”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“72.6 162/476 319/739 Male (I 2 = 14.7%) 0.66 (0.51-0.84)”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For the association between methylprednisolone and 28-day mortality, the fixed-effect OR was 0.80 (95% CI, 0.40-1.63;P = .54).”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Among the 6 trials that reported serious adverse events, 64 events occurred among 354 patients randomized to corticosteroids and 80 events occurred among 342 patients randomized to usual care or placebo.”
§ The WHO Rapid Evidence Appraisal > Abstract
plainn = 354- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 27
- It may state two separate claims as one. 16
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The extent of concurrent treatment with antiviral agents or azithromycin varied substantially among the trials (Table 2).”
§ The WHO Rapid Evidence Appraisal > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A total of 1703 patients were randomized (678 to corticosteroids and 1025 to usual care or placebo) in the 7 trials, the median age was 60 years (interquartile range, 52-68 years), and 488 patients (29%) were women (Table 2).”
§ The WHO Rapid Evidence Appraisal > Results
plainn = 1,703- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Five trials reported mortality at 28 days, 1 trial at 21 days, and 1 trial at 30 days.”
§ The WHO Rapid Evidence Appraisal > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The larger number of patients randomized to usual care or placebo was due to randomization in the RECOVERY trial (contributed 1007 [59.1%] patients to this analysis) in which patients were assigned to corticosteroid or usual care in a ratio of 1:2.”
§ The WHO Rapid Evidence Appraisal > Results
plaindirectn = 1,007- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In all trials, the majority of patients were male.”
§ The WHO Rapid Evidence Appraisal > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the proportions of patients with SARS-CoV-2 infection confirmed by polymerase chain reaction ranged from 78.7% to 100% across trials.”
§ The WHO Rapid Evidence Appraisal > Results
plainn = 1,703- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Among 695 patients from 6 trials for whom data were avail- able, 327 (47.0%) were receiving vasoactive agents for blood pressure support at randomization.”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups
plainn = 695- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The ORs for the association between corticosteroids and mortality appeared similar for older and younger individuals, men and women, and for longer and shorter durations of symptoms before randomization.”
§ The WHO Rapid Evidence Appraisal > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The trial for which the risk of bias was assessed as “some concerns” (Steroids-SARI; NCT04244591) was relatively small (47 patients and 26 deaths) and contributed only 3.5% of the weight in the primary meta-analysis.”
§ The WHO Rapid Evidence Appraisal > Limitations
plainn = 47- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“the trials were mainly conducted in high-income settings”
§ The WHO Rapid Evidence Appraisal > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The trial for which the risk of bias was assessed as “some concerns” (Steroids-SARI; NCT04244591) was relatively small (47 patients and 26 deaths) and contributed only 3.5% of the weight in the primary meta-analysis.”
§ The WHO Rapid Evidence Appraisal > Limitations
plainn = 47- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Adverse events varied across trials but there was no suggestion that the risk of serious adverse events was higher in patients assigned to corticosteroids except for the 2 smallest trials, in which the total number of serious adverse events was 1 and 3.”
§ The WHO Rapid Evidence Appraisal > Serious Adverse Events
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Inclusion of data from the Metcovid trial did not materially change the results other than reducing the inconsistency among the trials.”
§ The WHO Rapid Evidence Appraisal > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All trials contributed data according to age group and sex.”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All trials secured institutional review board approval, but approval was not required for the secondary data analysis reported here.Informed consent for participation in each trial was obtained and was consistent with local institutional review board requirements.”
§ The WHO Rapid Evidence Appraisal > Development of Prospective Meta-analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Comparisons between subgroups defined by trial characteristics were made using randomeffects meta-regression and interpreted as exploratory because of the small number of trials and the potential for confounding by other characteristics.”
§ The WHO Rapid Evidence Appraisal > Data Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The fifth subgroup was specified post hoc based on results from the RECOVERY trial.All other subgroup analyses were prespecified before any outcome data became available.”
§ The WHO Rapid Evidence Appraisal > Data Aggregation
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Because the definitions of serious adverse events varied among the trials, a meta-analysis of this outcome was not conducted.”
§ The WHO Rapid Evidence Appraisal > Data Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Risk of bias assessments were done independently by 4 of the investigators (A.G., J.P.T.H., M.H.M., and J.S.), with disagreements resolved through discussion.”
§ The WHO Rapid Evidence Appraisal > Risk of Bias Assessment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The primary analysis was an inverse variance-weighted fixed-effect meta-analysis of odds ratios (ORs) for overall mortality”
§ The WHO Rapid Evidence Appraisal > Data Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“There were minimal missing outcome data.Follow-up was complete for both mortality and serious adverse events for 4 of the 7 trials.”
§ The WHO Rapid Evidence Appraisal > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The Steroids-SARI trial (NCT04244591) recorded adverse events but did not categorize them as serious or nonserious adverse events.”
§ The WHO Rapid Evidence Appraisal > Serious Adverse Events
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Data were pooled from patients recruited to the participating trials through June 9, 2020, because patient management after that date was likely to be affected by the release of results of the RECOVERY trial on June 16, 2020.”
§ The WHO Rapid Evidence Appraisal > Development of Prospective Meta-analysis
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Patient management after June 9, 2020 was likely affected by the release of the RECOVERY trial results.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The protocol was registered and made publicly avail-able on the PROSPERO database (CRD42020197242) on July 6, 2020”
§ The WHO Rapid Evidence Appraisal > Development of Prospective Meta-analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“This was regarded as reflecting usual practice, 22 and was not considered to introduce a risk of bias in the effect of assignment to the intervention.”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality
What the sources say
- Not checked yetcites [22] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The optimal dose and duration of treatment could not be assessed in this analysis”
§ The WHO Rapid Evidence Appraisal > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The protocol and analysis plan, including specification of subgroup analyses, was registered and made publicly available on the PROSPERO database prior to data analysis or receipt of outcome data.”
§ The WHO Rapid Evidence Appraisal > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Third, there were only limited missing outcome data”
§ The WHO Rapid Evidence Appraisal > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Data from the Metcovid trial were not included in the primary meta-analysis because this trial was registered after the searches of the trial registries were conducted.”
§ The WHO Rapid Evidence Appraisal > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“in many trials, follow-up was censored when participants were discharged from the hospital.”
§ The WHO Rapid Evidence Appraisal > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The other 4 trials had unblinded outcome assessment, and the risk of bias was assessed as “some concerns” based on subjectivity implying that classification of serious adverse events could differ between intervention groups.”
§ The WHO Rapid Evidence Appraisal > Serious Adverse Events
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All subgroup analyses other than that comparing longer with shorter duration of symptoms at randomization were prespecified.”
§ The WHO Rapid Evidence Appraisal > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“As is standard in meta-analyses, patients were compared only with other patients randomized in the same trial.”
§ The WHO Rapid Evidence Appraisal > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This prospective meta-analysis was based on a relatively large number of critically ill patients with COVID-19 from geographically diverse sites who were randomized to receive corticosteroids or to receive usual care or placebo.”
§ The WHO Rapid Evidence Appraisal > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Nonetheless, the number of patients randomized in eligible trials who did not participate is likely to be smaller than the number of patients included in this meta-analysis.”
§ The WHO Rapid Evidence Appraisal > Limitations
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Nonetheless, the substantial risk of death in these patients (682/2604 [26.1%] in the control group) is consistent with mortality in critically ill patients with COVID-19.24,25”
§ The WHO Rapid Evidence Appraisal > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The protocol also has been published along with a structured abstract.8”
§ The WHO Rapid Evidence Appraisal > Discussion
What the sources say
- Not checked yetcites [8]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The authors state this as an assumption.
For illustrative absolute risk estimates, the mortality risk without corticosteroids was assumed to be 40%.
“we assumed a mortality risk without corticosteroids of 40% (approximately, the risk among all patients allocated to usual care or placebo)”
The authors state this as an assumption.
For subgroup absolute risk estimates, the mortality risk without corticosteroids was assumed to equal the observed risk among patients in that subgroup randomized to usual care or placebo.
“we assumed a mortality risk equal to the observed risk across patients in that subgroup who were randomized to usual care or placebo”
The paper relies on this without support.
Patient management after June 9, 2020 was likely affected by the release of the RECOVERY trial results.
“because patient management after that date was likely to be affected by the release of results of the RECOVERY trial on June 16, 2020”
The paper relies on this without support.
The effect of corticosteroids on 28-day mortality after discharge does not differ from the effect before discharge.
“We are aware of no reason that the effect of corticosteroids on postdischarge 28-day mortality would differ from that on predischarge mortality”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“However, the trials of sarilumab were generally done earlier in the pandemic than those of tocilizumab and before corticosteroids became the standard of care.7”
From Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19: A Meta-analysis (2021) · cites this paper as [7]
In the citing paper
“The tools varied by the type of reporting bias (publication bias or selective nonreporting bias) assessed; the target of assessment (e.g. an individual study or a meta-analysis of studies); and the criteria used to designate a study or meta-analysis as at risk of bias.”
From Investigating and dealing with publication bias and other reporting biases in meta-analyses of health research: a review (2021) · cites this paper as [42]
In the citing paper
“Various tools have been developed to assess selective nonreporting of results 42 .”
From Investigating and dealing with publication bias and other reporting biases in meta-analyses of health research: a review (2021) · cites this paper as [42]
In the citing paper
“All emphasize the importance of retrieving the study's protocol, registration record, or statistical analysis plan so that the planned outcomes and analyses can be compared with those that were reported 42 .”
From Investigating and dealing with publication bias and other reporting biases in meta-analyses of health research: a review (2021) · cites this paper as [42]
In the citing paper
“Some tools for assessing risk of reporting biases guide users to consider various qualitative signals that suggest additional results may be missing from studies that have not been identified 42 .”
From Investigating and dealing with publication bias and other reporting biases in meta-analyses of health research: a review (2021) · cites this paper as [42]
In the citing paper
“A systematic search for scales and checklists designed to help authors make a qualitative judgement about the risk of reporting biases identified 15 tools published up to February 2017 42 .”
From Investigating and dealing with publication bias and other reporting biases in meta-analyses of health research: a review (2021) · cites this paper as [42]
In the citing paper
“A meta-analysis of seven randomized trials showed that 28-day all-cause mortality in critically ill patients with Covid-19 was lower among those who were treated with glucocorticoids than among those who received usual care or placebo.100”
From Cytokine storm (2020) · cites this paper as [100]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“among patients who were not receiving invasive mechanical ventilation at randomization (corresponding to an absolute risk of 23% for corticosteroids vs 42% for usual care or placebo).”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups
Reported 42 · recomputed 37.837838
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“Among critically ill patients, many more were receiving invasive mechanical ventilation at randomization (1459 patients and 604 deaths) than were not (144 patients and 42 deaths).”
§ The WHO Rapid Evidence Appraisal > Association Between Corticosteroids and 28-Day All-Cause Mortality Within Subgroups
Reported 1459 · recomputed 1559
Citations
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Cited by
Sorted by citations
Items 801–900 of 1,001
How to Treat COVID-19 Patients at Home in the Italian Context: An Expert Opinion
Donno, D. R., Grattagliano, I., Rossi, A., Aprile, P. L., Medea, G., Lagolio, E., Granata, G., Petrosillo, N., & Cricelli, C. A. (2021) · Infectious Disease Reports · doi:10.3390/idr13010028 · Cited by 14
“Dexamethasone, a well-known corticosteroid, demonstrated a reduction in COVID-19 deaths by one-third in patients on ventilators and by one-fifth in those on oxygen [25].”
BackgroundA model to predict the risk of mortality in severely ill COVID-19 patients
Chen, B., Gu, H., Liu, Y., Zhang, G., Yang, H., Hu, H., Lu, C., Li, Y., Wang, L., (刘毅), Y. L., et al. (2021) · Computational and Structural Biotechnology Journal · doi:10.1016/j.csbj.2021.03.012 · Cited by 15
Smits, R. A. L., Trompet, S., van der Linden, C. M. J., van der Bol, J. M., Jansen, S. W. M., Polinder‐Bos, H. A., Willems, H. C., Barten, D. G., Blomaard, L. C., de Boer, M. G. J., et al. (2022) · Age and Ageing · doi:10.1093/ageing/afac048 · Cited by 15
“The beneficial effects of dexamethasone and low molecular weight heparin on in-hospital mortality have been proved in clinical trials [8, 22, 23].”
Méndez‐Flores, S., Priego-Ranero, Á. A., Azamar‐Llamas, D., Olvera‐Prado, H., Rivas‐Redonda, K. I., Ochoa‐Hein, E., Perez-Ortiz, A. C., Rendón-Macı́as, M. E., Rojas‐Castañeda, E., Urbina‐Terán, S., et al. (2022) · Clinical and Translational Medicine · doi:10.1002/ctm2.763 · Cited by 15
Lidou-Renault, V., Baudouin, É., Courtois-Amiot, P., Bianco, C., Esnault, H., Rouet, A., Baqué, M., Toméo, C., Rainone, A., Thietart, S., et al. (2022) · The Journals of Gerontology Series A · doi:10.1093/gerona/glac084 · Cited by 15
Kocks, J. W. H., Kerkhof, M., Scherpenisse, J., van de Maat, A., van Geer-Postmus, I., le Rütte, T. A., Schaart, J., Gans, R. O. B., & Kerstjens, H. A. M. (2022) · ERJ Open Research · doi:10.1183/23120541.00129-2022 · Cited by 15
ICU strain and outcome in COVID-19 patients—A multicenter retrospective observational study
Demoule, A., Fartoukh, M. S., Louis, G., Azoulay, É., Nemlaghi, S., Jullien, E., Desnos, C., Clerc, S., Yvin, É., Mellati, N., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0271358 · Cited by 15
Kumar, V., Bhushan, D., Supriya, S., Ganapule, A., Lohani, P., Shyama, S., Pandey, S., Majhi, P. K., Anand, U., Kumar, R., et al. (2022) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_2437_21 · Cited by 15
The effects of COVID-19 infection on the mortality of patients receiving rituximab therapy
Ekin, A., Coşkun, B. N., Dalkılıç, E., & Pehlivan, Y. (2022) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-022-03193-6 · Cited by 15
Gragueb-Chatti, I., Hyvernat, H., Léone, M., Agard, G., Peres, N., Guervilly, C., Boucékine, M., Hamidi, D., Papazian, L., Dellamonica, J., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11237097 · Cited by 14
A simple in-host model for COVID-19 with treatments: model prediction and calibration
Al‐Darabsah, I., Liao, K., & Portet, S. (2023) · Journal of Mathematical Biology · doi:10.1007/s00285-022-01849-6 · Cited by 15
“Toprevent theCOVID-19 progression and its longer-term complications, interventions are timely and early stage interventions have been shown to be essential (Prescott and Rice 2020; Sterne et al. 2020).”
BackgroundSharma, P. K., Kumar, L., Goswami, Y., Pujani, M., Dikshit, M., & Tandon, R. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1139654 · Cited by 17
Levinson, T., Wasserman, A., Shenhar‐Tsarfaty, S., Halutz, O., Shapira, I., Zeltser, D., Rogowski, O., Berliner, S. A., & Ziv‐Baran, T. (2023) · Clinical and Experimental Medicine · doi:10.1007/s10238-023-01176-0 · Cited by 15
“…a breakthrough in treating severe COVID-19 infected patients was made with the usage of anti-inflammatory medications such as glucocorticoids, IL-6 inhibitors, and JAK inhibitors, which underlies the significant role of inflammation in this disease as can be quantified by CRP level [35–38].”
Derde, L. P. G., Gordon, A. C., Mouncey, P., Al-Beidh, F., Rowan, K., Nichol, A., Arabi, Y. M., Annane, D., Beane, A., Beasley, R. W., et al. (2025) · Thorax · doi:10.1136/thorax-2024-222488 · Cited by 20
Self-citationWhy will it never be known if convalescent plasma is effective for COVID-19
Rojas, M., & Anaya, J. (2020) · Journal of Translational Autoimmunity · doi:10.1016/j.jtauto.2020.100069 · Cited by 15
The landscape of COVID‐19 trials in Australia
Seidler, A. L., Aberoumand, M., Williams, J. G., Tan, A., Hunter, K. E., & Webster, A. C. (2021) · The Medical Journal of Australia · doi:10.5694/mja2.51148 · Cited by 15
Asthma and COVID‐19: An early inpatient and outpatient experience at a US children's hospital
Farzan, S., Rai, S., Cerise, J. E., Bernstein, S., Coscia, G. T., Hirsch, J. S., Jeanty, J., Makaryus, M., McGeechan, S., McInerney, A., et al. (2021) · Pediatric Pulmonology · doi:10.1002/ppul.25514 · Cited by 15
Chan, K. W., Yu, K. Y., Lee, P. W., Lai, K. N., & Tang, S. C. W. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.678200 · Cited by 15
Kirkegaard-Biosca, C., Falcó-Roget, A., Sánchez‐Montalvá, A., Valls, Á., Clofent, D., Campos‐Varela, I., García, S. G., Leguízamo, L. M., Sellarès-Nadal, J., Eremiev, S., et al. (2021) · Infection · doi:10.1007/s15010-021-01662-1 · Cited by 15
Old Problem, New Concerns: Hypercortisolemia in the Time of COVID-19
Berlińska, A., Świątkowska−Stodulska, R., & Sworczak, K. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.711612 · Cited by 15
Therapeutic Emergency Use Authorizations (EUAs) During Pandemics: Double-edged Swords
Bhimraj, A., Morgan, R. L., Shumaker, A. H., Lavergne, V., Baden, L. R., Cheng, V. C., Edwards, K. M., Gandhi, R. T., Gallagher, J. C., Muller, W. J., et al. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab880 · Cited by 15
Malgie, J., Schoones, J. W., Zeegers, M. P., & Pijls, B. G. C. W. (2021) · Scientific Reports · doi:10.1038/s41598-021-00726-4 · Cited by 15
Antirheumatic Drugs against COVID-19 from the Perspective of Rheumatologists
Kawazoe, M., Kihara, M., & Nanki, T. (2021) · Pharmaceuticals · doi:10.3390/ph14121256 · Cited by 15
“In a meta-analysis that aggregated seven randomized trials and included data from 1703 critically ill patients with COVID-19, the administration of dexamethasone was found to reduce 28-day all-cause mortality rates more than usual care or placebo [55].”
MethodSecondary bloodstream infection in critically ill patients with COVID-19
Zhang, J., Lan, P., Jun, Y., Yang, C., Gong, X., Ge, H., Xu, X., Liu, L., Zhou, J., & Lv, F. (2021) · Journal of International Medical Research · doi:10.1177/03000605211062783 · Cited by 15
Anderegg, N., Panczak, R., Egger, M., Low, N. N., & Riou, J. (2022) · BMC Medicine · doi:10.1186/s12916-022-02364-7 · Cited by 16
Lonze, B. E., Spiegler, P. A., Wesson, R., Alachkar, N., Petkova, E., Weldon, E. P., Dieter, R. A., Li, Y., Quinn, M. M., Mattoo, A., et al. (2022) · Critical Care Medicine · doi:10.1097/ccm.0000000000005591 · Cited by 18
Dynamic Link Prediction for Discovery of New Impactful COVID-19 Research Approaches
Wang, X., Li, Y., Ban, T., Zhu, J., Chen, L., Usman, M., Wang, X., Chen, H., Chen, X., Leung, C., et al. (2022) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2022.3212863 · Cited by 15
Myeloid dysregulation and therapeutic intervention in COVID-19
Gu, R., Mao, T., Qiao, L., Su, T. T., & Wang, J. (2021) · Seminars in Immunology · doi:10.1016/j.smim.2021.101524 · Cited by 14
“The hypothesis was supported by the results from UK-based RECOVERY and other randomized controlled trials (RCT), which indicated that the use of anti-inflammatory agents, such as corticosteroids, was associated with reduced 28-day mortality compared with the standard of care among patients receiving oxygen support [12…”
Peng, H. T., Rhind, S. G., & Beckett, A. (2021) · JMIR Public Health and Surveillance · doi:10.2196/31554 · Cited by 16
Immunotherapy Management in Special Cancer Patient Populations
Ramnaraign, B. H., Chatzkel, J. A., Al‐Mansour, Z., Rogers, S. C., Jones, D. V., DeRemer, D. L., & George, T. J. (2021) · JCO Oncology Practice · doi:10.1200/op.20.00996 · Cited by 15
Sherman, A. C., Gray, G., Cao, B., To, K. K., Rouphael, N., Restrepo, A. M. H., Gordon, A. C., & Baden, L. R. (2025) · Nature Reviews Disease Primers · doi:10.1038/s41572-025-00662-x · Cited by 19
Self-citationGutiérrez‐Abejón, E., Tamayo, E., Martín-García, D., Alvarez, E., & Herrera‐Gómez, F. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249360 · Cited by 15
Sun, W. C., Liao, J., Yu, K., Qiu, J., Que, C.-L., Wang, G., & Ma, J. (2021) · BMC Infectious Diseases · doi:10.1186/s12879-021-06188-3 · Cited by 14
Naveen Naik, B., Puri, G. D., Kajal, K., Mahajan, V., Bhalla, A., Kataria, S., Singla, K., Panigrahi, P., Singh, A. P., Lazar, M., et al. (2021) · Cureus · doi:10.7759/cureus.20353 · Cited by 14
“Based on this assumption, researchers have been focusing on several interventions, including IL-6 inhibitors and corticosteroids [3-10].”
BackgroundMohanty, R. R., Padhy, B. M., & Meher, B. R. (2022) · Journal of Pharmacy & Pharmaceutical Sciences · doi:10.18433/jpps32430 · Cited by 14
Cytokine response over the course of COVID-19 infection in pregnant women
Rosen, D. B., Murphy, E. A., Gejman, R. S., Capili, A. M., Friedlander, R. L., Rand, S., Cagino, K. A., Glynn, S. M., Matthews, K. C., Kubiak, J. M., et al. (2022) · Cytokine · doi:10.1016/j.cyto.2022.155894 · Cited by 12
“2 COVID-19 patients reduced all-cause mortality by about 34% in a metaanalysis [8], further implicating immune overactivation in poor outcomes.”
Zochios, V., Brodie, D., Shekar, K., Schultz, M. J., & Parhar, K. K. S. (2022) · Anaesthesia · doi:10.1111/anae.15806 · Cited by 16
Rapid prediction of in-hospital mortality among adults with COVID-19 disease
Evans, D. S., Kim, K. M., Jiang, X., Jacobson, J., Browner, W. S., & Cummings, S. R. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269813 · Cited by 14
“Notably, after considering other variables, race and ethnicity were not significant predictors of mortality, as has been seen in other studies [9, 14, 29].”
ResultThe role of platelets, neutrophils and endothelium in COVID-19 infection
Falcinelli, E., Petito, E., & Gresele, P. (2022) · Expert Review of Hematology · doi:10.1080/17474086.2022.2110061 · Cited by 14
Cardiovascular complications of COVID-19 severe acute respiratory syndrome.
Henning, R. J. (2022) · PubMed Central · Cited by 14
Effect of corticosteroids in patients with COVID-19: a Bayesian network meta-analysis
Wang, X., Wen, D., He, Q., Yang, J., You, C., Tao, C., & Ma, L. (2022) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2022.10.021 · Cited by 14
“(Sterne et al., 2020) concluded that the use of systemic”
BackgroundOliver, J. C., Silva, E. N., Soares, L. M., Scodeler, G. C., Santos, A. D. S., Corsetti, P. P., Prudêncio, C. R., & de Almeida, L. A. (2022) · Therapeutic Advances in Vaccines and Immunotherapy · doi:10.1177/25151355221144845 · Cited by 14
Incidence and Impact of Acute Pericarditis in Hospitalized Patients With COVID‐19
Li, P., Shi, A., Lu, X., Li, C., Cai, P., Teng, C., Liu, B., Wu, L., Liu, Q., & Wang, B. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.122.028970 · Cited by 14
He, Q., Wang, C., Wang, Y., Chen, G., Zhou, Y., Wu, Y., & Zhong, M. (2023) · BMC Infectious Diseases · doi:10.1186/s12879-023-08874-w · Cited by 14
Willis, Z., Oliveira, C. R., Abzug, M. J., Anosike, B. I., Ardura, M. I., Bio, L. L., Boguniewicz, J., Chiotos, K., Downes, K. J., Grapentine, S. P., et al. (2023) · Journal of the Pediatric Infectious Diseases Society · doi:10.1093/jpids/piad116 · Cited by 14
Wang, Y., Yan, X., Huang, C., Sun, Y., Yao, C., Lin, Y., & Xiao, W. (2020) · Current Medical Research and Opinion · doi:10.1080/03007995.2020.1853508 · Cited by 14
Thromboses and COVID-19: reducing inflammation in addition to thromboprophylaxis
Mehta, P., Haskard, D. O., Laffan, M., Chambers, R. C., & Hunt, B. J. (2021) · The Lancet Rheumatology · doi:10.1016/s2665-9913(21)00003-5 · Cited by 14
Do-not-intubate status and COVID-19 mortality in patients admitted to Dutch non-ICU wards
van der Veer, T., der Brugge, S. V. D. S., Paats, M. S., van Nood, E., Backer, I. D., Aerts, J. G. J. V., & van der Eerden, M. M. (2021) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-021-04223-4 · Cited by 14
Uremia-Associated Immunological Aging and Severity of COVID-19 Infection
Betjes, M. G. H. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.675573 · Cited by 15
Incorporating Adult Evidence Into Pediatric Research and Practice
Murthy, S., Fontela, P. S., & Berry, S. M. (2021) · JAMA · doi:10.1001/jama.2020.25007 · Cited by 14
Self-citationLiu, D., Ding, H., Chen, Y., Chen, D., Yang, C., Yang, L., Liu, J. A., Zhang, L., Xia, Z., Zhang, X.-H., et al. (2021) · Aging · doi:10.18632/aging.203532 · Cited by 14
van Haren, F. M. P., Laffey, J. G., Artigas, A., Page, C. P., Schultz, M. J., Cosgrave, D. W., McNicholas, B., Smoot, T. L., Nunes, Q. M., Richardson, A., et al. (2022) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.15253 · Cited by 13
Cytokine Storm and its Implication in Coronavirus disease 2019 (COVID-19)
Datta, C., & Bhattacharjee, A. (2020) · Journal of Immunological Sciences · doi:10.29245/2578-3009/2020/2.1190 · Cited by 14
Lan, S., Hsu, C., Lai, C., Chang, S.-P., Lu, L., Hung, S., & Lin, W. (2022) · Annals of Medicine · doi:10.1080/07853890.2022.2096919 · Cited by 14
Blanca, D., Nicolosi, S., Bandera, A., Blasi, F., Mantero, M., Hu, C. M., Amicis, M. M. D., Lucchi, T. A., Schinco, G. L., Peyvandi, F., et al. (2022) · Internal and Emergency Medicine · doi:10.1007/s11739-022-03052-3 · Cited by 14
Shah, M. D., Reveles, K. R., Moote, R., Hand, E., Kellogg, D. L., Attridge, R. L., Maselli, D. J., & Gutierrez, G. (2023) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofad062 · Cited by 14
“While the benefit of corticosteroids in COVID-19 treatment is clear, a variety of data utilizing different regimens has led to wide variations in practice [1, 4].”
BackgroundCurrent and New Drugs for COVID-19 Treatment and Its Effects on the Liver
Satsangi, S., Gupta, N. R., & Kodan, P. (2021) · Journal of Clinical and Translational Hepatology · doi:10.14218/jcth.2020.00174 · Cited by 14
Corticosteroid Use in Otolaryngology: Current Considerations During the COVID‐19 Era
Chang, C. W. D., McCoul, E. D., Briggs, S. E., Guardiani, E. A., Durand, M. L., Hadlock, T. A., Hillel, A. T., Kattar, N., Openshaw, P., Osazuwa‐Peters, N., et al. (2021) · Otolaryngology · doi:10.1177/01945998211064275 · Cited by 16
Zabolotskikh, I. B., Кirov, М. Y., Лебединский, К. М., Николаевич, П. Д., Avdeev, S. N., Andreenko, A. A., Arsentev, L. V., Афончиков, В. С., Игоревич, А. И., Belkin, A. A., et al. (2022) · Annals of critical care · doi:10.21320/1818-474x-2022-1-5-140 · Cited by 13
Covid-19: Hydrocortisone can be used as alternative to dexamethasone, review finds
Mahase, E. (2020) · BMJ · doi:10.1136/bmj.m3472 · Cited by 14
Impact of Systemic Corticosteroids on Mortality in Older Adults With Critical COVID-19 Pneumonia
Piniella-Ruiz, E., Bellver-Álvarez, M. T., Mestre-Gómez, B., Escolano-Fernández, B., Vinat-Prado, S., Cabezas-Olea, R., Acedo-Gutiérrez, M. S., Akasbi, M., Ryan, P., Bustamante‐Fermosel, A., et al. (2021) · The Journals of Gerontology Series A · doi:10.1093/gerona/glab074 · Cited by 13
COVID-19 en pediatría: valoración crítica de la evidencia
Rodríguez, P. G., Pérez‐Moneo, B., Rodríguez, M. S. A., Galdeano, P. A., Rodrigo, M. A., Rodríguez, M. M. F., Olcina, M. J. E., & Sangrador, C. O. (2021) · Anales de Pediatría · doi:10.1016/j.anpedi.2021.05.019 · Cited by 15
Steroid therapy for COVID-19: A systematic review and meta-analysis of randomized controlled trials
Boppana, T. K., Mittal, S., Madan, K., Mohan, A., Hadda, V., Tiwari, P., & Guleria, R. (2021) · Monaldi Archives for Chest Disease · doi:10.4081/monaldi.2021.1716 · Cited by 13
Fatal disseminated mucormycosis associated with COVID ‐19
Horiguchi, T., Tsukamoto, T., Toyama, Y., Sasaki, T., Nakamura, T., Sakurai, A., Kuriyama, N., Komatsu, S., Shigeyasu, Y., Ina, T., et al. (2022) · Respirology Case Reports · doi:10.1002/rcr2.912 · Cited by 13
The Interrelationship between Diabetes Mellitus and COVID-19
Abed, T. A., & Chabuck, Z. A. G. (2022) · Medical Journal of Babylon · doi:10.4103/mjbl.mjbl_11_22 · Cited by 13
Lai, C., Chen, W., Chen, C.-Y., & Wei, Y. (2022) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2022.2098112 · Cited by 13
Remuzzi, G., Schiaffino, S., Santoro, M. G., FitzGerald, G. A., Melino, G., & Patrono, C. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.987816 · Cited by 16
Rondović, G., Djordjevic, D., Udovičić, I., Stanojević, I., Zeba, S., Abazovic, T., Vojvodić, D., Abazović, D., Khan, W. S., & Šurbatović, M. (2022) · Biomedicines · doi:10.3390/biomedicines10102620 · Cited by 14
Dechamps, M., Poortere, J. D., Octave, M., Ginion, A., Robaux, V., Pirotton, L., Bodart, J., Gruson, D., van Dievoet, M., Douxfils, J., et al. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24087278 · Cited by 13
Lopinto, J., Arrestier, R., Peiffer, B., Gaillet, A., Voiriot, G., Urbina, T., Luyt, C. E., Bellaïche, R., Pham, T. O., Hamou, Z. A., et al. (2023) · Critical Care Medicine · doi:10.1097/ccm.0000000000005930 · Cited by 13
Yu, Z., Zheng, Y., Chen, B., Lv, J., Zhu, X., Shang, B., Xv, Y., Ru, T., Yang, Y., Cong, J., et al. (2023) · Phytomedicine · doi:10.1016/j.phymed.2023.155025 · Cited by 13
Bartoszewicz, M., Czaban, S. L., Bartoszewicz, K., Kuźmiuk, D., & Ładny, J. R. (2023) · Therapeutic Advances in Infectious Disease · doi:10.1177/20499361231207178 · Cited by 13
“19,20 This may inform further research regarding the efficacy and safety of different treat-ment strategies for COVID-19, including the role of other medications such as tocilizumab or other drugs targeting cytokines, which modulate the immune response and may influence the risk of bacterial…”
BackgroundFrom Emergence to Endemicity: A Comprehensive Review of COVID-19
Naik, R., Avula, S., Palleti, S. K., Gummadi, J., Ramachandran, R., Chandramohan, D., Dhillon, G. S., Gill, A. S., Paiwal, K., Shaik, B. F., et al. (2023) · Cureus · doi:10.7759/cureus.48046 · Cited by 17
Vale, C. L., Godolphin, P. J., Fisher, D. J., Horby, P., Kosiborod, M., Hochman, J. S., Webster, K. E., Higgins, J. P. T., Althouse, A. D., Berwanger, O. B., et al. (2024) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(24)00219-5 · Cited by 14
Self-citationImmunity and Coagulation in COVID-19
Авдонин, П. П., Blinova, M. S., Serkova, A. A., Komleva, L. A., & Avdonin, P. V. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252011267 · Cited by 17
Dexamethasone Treatment for Covid-19, a Curious Precedent Highlighting a Regulatory Gap
Gozzo, L., Longo, L., Vitale, D. C., & Drago, F. (2020) · Frontiers in Pharmacology · doi:10.3389/fphar.2020.621934 · Cited by 13
Luo, S., Hu, W., Lu, Z., Chang, L., Fan, Y.-M., Chen, Q.-J., Chen, Z.-S., Ye, J., Chen, S., Tong, J., et al. (2021) · World Journal of Diabetes · doi:10.4239/wjd.v12.i10.1789 · Cited by 13
Severe COVID-19 pneumonia in Piacenza, Italy — A cohort study of the first pandemic wave
Guglielmetti, L., Kontsevaya, I., Leone, M. C., Ferrante, P., Fronti, E., Gerna, L., Valdatta, C., Donisi, A., Faggi, A., Paolillo, F., et al. (2020) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2020.11.012 · Cited by 13
Tamura, K., Nishioka, S., Tamura, N., Saito, Z., & Kuwano, K. (2020) · Respiratory Medicine Case Reports · doi:10.1016/j.rmcr.2020.101318 · Cited by 13
“The prospective meta-analysis of clinical trials including the RECOVERY trial also showed that systemic corticosteroids were effective on critically ill patients with COVID-19 [3].”
Dravid, A. N., Kashiva, R., Khan, Z. A., Memon, D., Kodre, A., Potdar, P., Mane, M., Borse, R., Pawar, V., Patil, D. H., et al. (2021) · Medicine · doi:10.1097/md.0000000000026705 · Cited by 12
Gallay, L., Tran, V.-T., Perrodeau, É., Vignier, N., Mahévas, M., Bisio, F., Forestier, E., Lescure, F.-X., Gallay, L., Tran, V.-T., et al. (2021) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2021.03.021 · Cited by 13
“Third, they excluded patients with organ failure at baseline, including those who required immediate admission to the intensive care unit (ICU) and those requiring non-invasive ventilation.”
ResultInfluentialFusina, F., Albani, F., Granato, E., Meloni, A., Rozzini, R., Sabatini, T., Stellini, R., Terragnoli, P., Rosanò, A., Hilal, M. A., et al. (2021) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.2245 · Cited by 13
Use of Anti-Cytokine Therapy in Kidney Transplant Recipients with COVID-19
Bodro, M., Cofán, F., Ríos, J., Herrera, S., Linares, L., Marcos, M. Á., Soriano, À., Moreno, A., & Diekmann, F. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10081551 · Cited by 13
Drug delivery systems as immunomodulators for therapy of infectious disease: Relevance to COVID-19
Brain, D. E., Plant-Hately, A. J., Heaton, B. J., Arshad, U., David, C. A. W., Hedrich, C. M., Owen, A., & Liptrott, N. J. (2021) · Advanced Drug Delivery Reviews · doi:10.1016/j.addr.2021.113848 · Cited by 13
Diagnosis and Management Considerations in Steroid-Related Hyperglycemia in COVID-19
Das, S., Rastogi, A., Harikumar, K. V. S., Dutta, D., Sahay, R. K., Kalra, S., Ghosh, S. K., Gupta, S. K., Pandit, K., Jabbar, P. K., et al. (2021) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_227_21 · Cited by 13
Gomes, N. T. N., Haslett, M. I. C., Alves, A. J. S. E., Pércio, J., Duarte, M. M. S., Malta, J. M. A. S., de Carvalho, F. C., de Almeida, W. A. F., Gava, C., Souza, L. R. D. O., et al. (2020) · Revista Brasileira de Epidemiologia · doi:10.1590/1980-549720200026 · Cited by 13
Naseem, M., Arshad, H., Hashmi, S. A., Irfan, F. B., & Ahmed, F. S. (2021) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2021.104556 · Cited by 15
“steroids(33) as an early symptom of COVID-19 had better prognosis in our patient”
BackgroundFernández‐Martínez, N. F., Ortiz-González-Serna, R., Serrano-Ortiz, Á., Rivera‐Izquierdo, M., Ruiz-Montero, R., Pérez-Contreras, M., de Alba, I. G.-F., Romero-Duarte, Á., & Salcedo-Leal, I. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18179018 · Cited by 13
Douin, D. J., Krause, M., Williams, C., Tanabe, K., Fernandez-Bustamante, A., Quaye, A., Ginde, A. A., & Bartels, K. (2021) · Seminars in Cardiothoracic and Vascular Anesthesia · doi:10.1177/10892532211043313 · Cited by 13
“002 Days with glucose <80 or >180 mg/dL 6 (2-17) 12 (4-18) 5 (1-14) .”
InfluentialA Potential Role of the CD47/SIRPalpha Axis in COVID-19 Pathogenesis
McLaughlin, K.-M., Bojková, D., Kandler, J. D., Bechtel, M., Reus, P., Le, T. T., Rothweiler, F., Wagner, J. U. G., Weigert, A., Ciesek, S., et al. (2021) · Current Issues in Molecular Biology · doi:10.3390/cimb43030086 · Cited by 13
Ranhel, D., Ribeiro, A., Batista, J., Pessanha, M. A., Cristovam, E., Duarte, A., Dias, A., Coelho, L., Monteiro, F. B., Freire, P., et al. (2021) · Journal of Fungi · doi:10.3390/jof7100881 · Cited by 13
Characteristics of published/registered clinical trials on COVID-19 treatment: A systematic review
Asili, P., Mirahmad, M., Tabatabaei‐Malazy, O., Manayi, A., Haghighat, E., Mahdavi, M. R., & Larijani, B. A. (2021) · DARU Journal of Pharmaceutical Sciences · doi:10.1007/s40199-021-00422-8 · Cited by 13
COVID-19 and the liver: A brief and core review
Kayaaslan, B., & Güner, R. (2021) · World Journal of Hepatology · doi:10.4254/wjh.v13.i12.2013 · Cited by 13
Branch‐Elliman, W., Ferguson, R. E., Doros, G. D., Woods, P. A., Leatherman, S. M., Strymish, J. M., Datta, R., Goswami, R., Jankowich, M. D., Shah, N. R., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0263591 · Cited by 13
Lee, K. M., Heberer, K. R., Gao, A., Becker, D. J., Loeb, S., Makarov, D. V., Gulanski, B., DuVall, S. L., Aslan, M., Lee, J. S., et al. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.774773 · Cited by 16
Hospital-acquired infections in patients hospitalized with COVID-19: First report from Taiwan
Huang, R.-C., Chiu, C.-H., Chiang, T.-T., Tsai, C.-C., Wang, Y.-C., Chang, F., Yang, Y., & Wang, C.-H. (2022) · Journal of the Chinese Medical Association · doi:10.1097/jcma.0000000000000764 · Cited by 13
Crooks, C. J., West, J., Fogarty, A., Morling, J. R., Grainge, M. J., Gonem, S., Simmonds, M., Race, A., Juurlink, I., Briggs, S., et al. (2022) · American Journal of Epidemiology · doi:10.1093/aje/kwac126 · Cited by 13
“This is likely to reflect the change in demographic characteristics and clinical practice between the first and second UK waves of the SARS-CoV-2 pandemic, given changes in escalation practice (16, 17) and the introduction of the use of steroids (18, 19).”
Bao, W. J., Fu, S. K., Zhang, H., Zhao, J., Jin, H. M., & Yang, X. H. (2022) · New Microbes and New Infections · doi:10.1016/j.nmni.2022.101058 · Cited by 13
Pitre, T., Su, J. S., Mah, J. C., Helmeczi, W., Danho, S., Plaxton, W., Giilck, S., Rochwerg, B. N., & Zeraatkar, D. (2022) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202208-720oc · Cited by 14
Zysman, M., Asselineau, J., Saut, O., Frison, É., Oranger, M., Maurac, A., Charriot, J., Achkir, R., Regueme, S. C., Klein, É., et al. (2023) · European Radiology · doi:10.1007/s00330-023-09759-x · Cited by 13
Metadata
- Authors
- The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne, J. A. C., Murthy, S., Diaz, J. V., Slutsky, A. S., Villar, J., Angus, D. C., Annane, D., Azevedo, L. C. P., Berwanger, O., Cavalcanti, A. B., Dequin, P.-F., Du, B., Emberson, J., Fisher, D., Giraudeau, B., Gordon, A. C., Granholm, A., Green, C., Haynes, R., Heming, N., Higgins, J. P. T., Horby, P., Jüni, P., Landray, M. J., Le Gouge, A., Leclerc, M., Lim, W. S., Machado, F. R., McArthur, C., Meziani, F., Møller, M. H., Perner, A., Petersen, M. W., Savovic, J., Tomazini, B., Veiga, V. C., Webb, S., & Marshall, J. C.
- Affiliations
- University of Bristol (GB)
- University of British Columbia (CA)
- St. Michael's Hospital (CA)
- University of Pittsburgh (US)
- Universidade de São Paulo (BR)
- Hospital Sírio-Libanês, São Paulo, Brazil
- Hospital Israelita Albert Einstein (BR)
- Université de Tours (FR)
- Médecine Intensive-Réanimation, INSERM CIC1415, CHRU de Tours, Tours, France
- Peking Union Medical College Hospital (CN)
- University of Oxford (GB)
- Inserm (FR)
- University of Copenhagen (DK)
- Université de Versailles Saint-Quentin-en-Yvelines (FR)
- CIC INSERM 1415-CHRU de Tours, Tours, France
- Nottingham University Hospitals NHS Trust (GB)
- Anesthesiology, Pain, and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
- St John of God Subiaco Hospital (AU)
- Corresponding author
- Sterne, Jonathan A. C.
- ORCID
- Sterne, Jonathan A. C.
- Murthy, Srinivas
- Diaz, Janet V.
- Slutsky, Arthur S.
- Villar, Jesús
- Angus, Derek C.
- Annane, Djillali
- Berwanger, Otavio
- Cavalcanti, Alexandre B.
- Du, Bin
- Emberson, Jonathan
- Fisher, David
- Giraudeau, Bruno
- Gordon, Anthony C.
- Granholm, Anders
- Green, Cameron
- Haynes, Richard
- Heming, Nicholas
- Higgins, Julian P. T.
- Horby, Peter
- Jüni, Peter
- Landray, Martin J.
- Lim, Wei Shen
- McArthur, Colin
- Meziani, Ferhat
- Møller, Morten Hylander
- Perner, Anders
- Tomazini, Bruno
- Veiga, Viviane C.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2020-10-06
- Volume
- 324
- Issue
- 13
- Pages
- 1330
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC7489434
- OpenAlex
- W3082355253
- Semantic Scholar
- c40537695ad1c573a608449e4ff9bb6bc94c3dab
- Cited by
- 2,257
- References
- 30
- Citations by year
- 2026: 39 · 2025: 92 · 2024: 175 · 2023: 302 · 2022: 538 · 2021: 906 · 2020: 204
- FWCI
- 63.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (acceptedVersion, other-oa)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- HAL (submittedVersion)
- Funders
- Amgen
- Pfizer
- AstraZeneca
- World Health Organization
- Nottingham University Hospitals NHS Trust
- University Hospitals Bristol NHS Foundation Trust
- UK Research and Innovation
- Medicines Company
- National Institute for Health and Care Research (11/46/14, NF-SI-0616-10111, COVID-19, NF-SI-0617-10145, RP-2015-06-018)
- University of Oxford
- University of Nottingham
- Institut National de la Santé et de la Recherche Médicale
- Monash University
- University of Toronto
- Novo Nordisk
- Rigshospitalet
- Universidade de São Paulo
- Oxford University Hospitals NHS Foundation Trust
- Novo Nordisk Fonden (NNF20SA0062998)
- Universidade do Estado do Amazonas
- Minderoo Foundation
- Abbott Vascular
- Canadian Institutes of Health Research
- Medical Research Council (MC_UU_12023/22, MC_UU_12023/21, MC_UU_00017/3, MC_PC_20062)
- National Health and Medical Research Council
- Health Research Council of New Zealand
- NIHR Oxford Biomedical Research Centre
- Health Data Research UK
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- COVID-19 pandemic, systemic corticosteroids, dexamethasone, cortisol, methylprednisolone, 28-day mortality, critically ill patients, serious adverse events, corticosteroid therapy, risk of bias, subgroup analysis, risk of bias assessment
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Drug Treatment, Adrenal Cortex Hormones, Cause of Death, Dexamethasone, Glucocorticoids, Humans, Hydrocortisone, Methylprednisolone, Pneumonia, Viral, Randomized Controlled Trials as Topic, Critical Illness, Coronavirus Infections, Pandemics
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