Abstract

CORTICOTHERAPY AND COVID-19 HOSPITALIZED PATIENT MORTALITY - IMPACT OF STUDY DESIGN, TEMPORALITY AND PUBLICATION STATUS ON STUDY RESULTS: A META-ANALYSIS

Akunga Nahashon G.*, Murithi Mary K.

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Abstract

Background: COVID-19, a viral infection of the respiratory system causes inflammation that can compromise lung function. Corticosteroids have been used to treat this inflammatory response though the efficacy is still debatable. Objective: To assess whether study design, temporality, and publication status influenced the reported efficacy of corticosteroids in reducing mortality among hospitalized COVID-19 patients.. Methods: Studies were retrieved from PubMed, Google Scholar and MEDRXIV. Eligible studies were those conducted between 2019 and 2024, had a clear endpoint (mortality), had a treatment group (corticosteroid group) and a control (no corticosteroids). The pooled risk difference in mortality between corticosteroid treated and corticosteroid-untreated was computed taking into account study design, publication status (i.e., peer-reviewed vs. preprint) and the timing (temporality) of when the studies were conducted. Results: Nineteen studies involving 21,583 participants were analyzed. The overall pooled risk difference in mortality between corticosteroid-treated and untreated patients was 0.01 (95% CI: -0.03, 0.05). Nine randomized controlled trials (RCTs) with 9,537 patients showed a pooled risk difference of -0.05 (95% CI: -0.10, 0.01), while 11 cohort studies with 12,046 patients had a pooled risk difference of 0.05 (95% CI: -0.01, 0.11). The difference in effect between RCTs and cohort studies was statistically significant (p = 0.02). Thirteen published studies (11,362 participants) had a pooled risk difference of -0.02 (95% CI: -0.08, 0.03), compared to six unpublished studies (10,221 participants) with a pooled risk difference of 0.05 (95% CI: -0.01, 0.12). The difference between published and unpublished studies was not statistically significant ( p = 0.08 Eight studies conducted during or before 2020 (10,438 participants) had a pooled risk difference of 0.00 (95% CI: 0.06, 0.07), while 11 studies conducted after 2020 (11,145 partici pants) had a pooled risk difference of 0.01 (95% CI: 0.05, 0.06). There was no significant difference between studies conducted during or before 2020 and those conducted after (p = 0.9 9 ).Corticosteroids do not significantly reduce the risk of mortality am ong hospitalized COVID 19 patients overall. However, a significant difference was observed between randomized controlled trials (RCTs) and cohort studies, with RCTs suggesting a possible benefit of corticosteroids compared to cohort studies. These findings underscore the influence of study design on treatment outcomes and highlight the need for cautious interpretation of non randomized evidence.

Keywords: COVID 19, Corticosteroids , Study Design , Mortality , Corticotherapy Publication , Temporality , RCT, CO HORT