scholarly journals Calming the Storm: A review of corticosteroid use in severely ill COVID-19 patients on mechanical ventilation

2021 ◽  
Vol 2 (4) ◽  
pp. 132-141
Author(s):  
Tran Dinh ◽  
Cherie Chu
Keyword(s):  
Lung Inflammation ◽  
Clinical Evidence ◽  
Meta Analysis ◽  
Supplemental Oxygen ◽  
Randomized Controlled ◽  
Therapeutic Guidelines ◽  
The World ◽  
Keywords Corticosteroids ◽  
Review Current

The importance of corticosteroids in the therapy of COVID-19 has been controversial. However, as the world develops a better understanding regarding the pathophysiology of COVID-19, we are realizing that suppressing the host immune response may reduce lung inflammation preventing further complications. In addition, more high-quality randomized controlled trials, meta-analysis, and review articles are being published discussing the role of corticosteroids. Majority of these studies concluded that corticosteroids are beneficial for hospitalized severely ill COVID-19 patients requiring supplemental oxygen. To date, therapeutic guidelines for COVID-19 patients recommend dexamethasone or other alternative corticosteroids, including methylprednisolone, hydrocortisone, or prednisone, as a treatment choice for severely ill COVID-19 patients. This review will discuss the pharmacology, mechanism of action, pharmacodynamics, pharmacokinetics, and benefits of corticosteroids in COVID-19 patients, and review current published clinical evidence on corticosteroids. Keywords: Corticosteroids, COVID-19, ARDS

scholarly journals β1-blocker in sepsis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Daisuke Hasegawa ◽  
Ryota Sato ◽  
Osamu Nishida
Keyword(s):  
Heart Rate ◽  
Oxygen Delivery ◽  
Sinus Tachycardia ◽  
Meta Analysis ◽  
Lactate Production ◽  
Volume Index ◽  
Initial Resuscitation ◽  
Randomized Controlled ◽  
Metabolic Systems

Abstract Background The use of ultrashort-acting β1-blockers recently has attracted attention in septic patients with non-compensatory tachycardia. We summarized the metabolic and hemodynamic effects and the clinical evidence of ultrashort-acting β1-blockers. Main body A recent meta-analysis showed that ultrashort-acting β1-blockers reduced the mortality in septic patients with persistent tachycardia. However, its mechanism to improve mortality is not fully understood yet. We often use lactate as a marker of oxygen delivery, but an impaired oxygen use rather than reduced oxygen delivery has been recently proposed as a more reasonable explanation of hyperlactatemia in patients with sepsis, leading to a question of whether β1-blockers affect metabolic systems. While the stimulation of the β2-receptor accelerates glycolysis and lactate production, the role of β1-blocker in lactate production remains unclear and studies investigating the role of β1-blockers in lactate kinetics are warranted. A meta-analysis also reported that ultrashort-acting β1-blockers increased stroke volume index, while it reduced heart rate, resulting in unchanged cardiac index, mean arterial pressure, and norepinephrine requirement at 24 h, leading to an improvement of cardiovascular efficiency. On the other hand, a recent study reported that heart rate reduction using fast esmolol titration in the very early phase of septic shock caused hemodynamic instability, suggesting that ultrashort-acting β1-blockers should be started only after completing initial resuscitation. While many clinicians still do not feel comfortable controlling sinus tachycardia, one randomized controlled trial in which the majority had sinus tachycardia suggested the mortality benefit of ultrashort-acting β1-blockers. Therefore, it still deems to be reasonable to control sinus tachycardia with ultrashort-acting β1-blockers after completing initial resuscitation. Conclusion Accumulating evidence is supporting the use of ultrashort-acting β1-blockers while larger randomized controlled trials to clarify the effect of ultrashort-acting β1-blockers are still warranted.

scholarly journals Vitamin D supplementation, COVID-19 and disease severity: a meta-analysis

QJM ◽  
2021 ◽  
Author(s):  
K Shah ◽  
D Saxena ◽  
D Mavalankar
Keyword(s):  
Vitamin D ◽  
Randomized Controlled Trials ◽  
Usual Care ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Vitamin D Supplementation ◽  
Hospitalized Patients ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Objective: Current meta-analysis aims to understand the effect of oral supplementation of vitamin D on intensive care unit (ICU) requirement and mortality in hospitalized COVID-19 patients. Methods: Databases PubMed, preprint servers, and google scholar were searched from December 2019 to December 2020. Authors searched for the articles assessing role of vitamin D supplementation on COVID-19. Cochrane RevMan tool was used for quantitative assessment of the data, where heterogeneity was assessed using I2 and Q statistics and data was expressed using odds ratio with 95% confidence interval. Results: Final meta-analysis involved pooled data of 532 hospitalized patients (189 on vitamin D supplementation and 343 on usual care/placebo) of COVID-19 from three studies (Two randomized controlled trials, one retrospective case-control study). Statistically (p<0.0001) lower ICU requirement was observed in patients with vitamin D supplementation as compared to patients without supplementations (odds ratio: 0.36; 95% CI: 0.210-0.626). However, it suffered from significant heterogeneity, which reduced after sensitivity analysis. In case of mortality, vitamin D supplements has comparable findings with placebo treatment/usual care (odds ratio: 0.93; 95% CI: 0.413-2.113; p=0.87). The studies did not show any publication bias and had fair quality score. Subgroup analysis could not be performed due to limited number of studies and hence dose and duration dependent effect of vitamin D could not be evaluated. Conclusions: Although the current meta-analysis findings indicate potential role of vitamin D in improving COVID-19 severity in hospitalized patients, more robust data from randomized controlled trials are needed to substantiate its effects on mortality.

A perspective on role of calcium and vitamin D in cardiovascular outcomes and lipid profile

2015 ◽  
Vol 26 (5) ◽  
Author(s):  
Tarun Arora ◽  
Harmeet Singh Rehan
Keyword(s):  
Vitamin D ◽  
Calcium Supplementation ◽  
Meta Analysis ◽  
Disease Status ◽  
Controlled Trials ◽  
Lipid Levels ◽  
Randomized Controlled ◽  
The Past ◽  
Vitamin D Supplements

AbstractRecent concerns on increased incidence of myocardial infarction and stroke on administration of calcium and vitamin D supplements have alarmed the physicians about safety of these drugs. Although both calcium and vitamin D have been shown in the past to have beneficial effect on cardiovascular disease status through lowering of harmful lipids, these findings have been contradicted by some recent meta-analysis and randomized controlled trials that have shown no beneficial or in some cases a deteriorating effect of these supplements on lipid levels. In particular, calcium supplementation has been associated more with increased incidence of cardiovascular morbidity than vitamin D, but the convincing proof is still lacking. Here we have highlighted the results of some significant studies that might impact the prescription of these drugs.

scholarly journals Impact of Flavonols on Cardiometabolic Biomarkers: A Meta‐Analysis of Randomized Controlled Human Trials to Explore the Role of Inter‐Individual Variability

Nutrients ◽  
2017 ◽  
Vol 9 (2) ◽  
pp. 117 ◽  
Author(s):  
Regina Menezes ◽  
Ana Rodriguez‐Mateos ◽  
Antonia Kaltsatou ◽  
Antonio González‐Sarrías ◽  
Arno Greyling ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Individual Variability ◽  
Human Trials ◽  
Randomized Controlled

scholarly journals Efficacy of Ursodeoxycholic Acid in Nonalcoholic Fatty Liver Disease: An Updated Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Author(s):  
Wenyue Zhang ◽  
Yao Tang ◽  
Juan Huang ◽  
Hong Ren ◽  
Yixuan Yang ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Ursodeoxycholic Acid ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Total Bilirubin ◽  
Meta Analysis ◽  
Nonalcoholic Fatty Liver ◽  
Randomized Controlled

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is a kind of chronic liver disease among general population. Recent years, more and more new experiments have made the role of ursodeoxycholic acid (UDCA) become clearer. In this meta-analysis, we analyzed the efficacy of ursodeoxycholic acid (UDCA) for the treatment of nonalcoholic fatty liver disease (NAFLD). Methods We searched the Web of Science, Pubmed, Embase and Cochrane library databases for relavent studies published before March 1, 2019. We examined 134 randomized controlled trials (RCTs) that investigated the effectiveness of UDCA in NAFLD against placebo or other treatments. Next, we conducted meta-analysis by Stata(version 12.0) to examine the change among several indices: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), Alkaline phosphatase (AP), total bilirubin and albumin. Results Following the application of different inclusion and exclusion criteria, 9 articles with 1106 participants were finally selected. The forest plot displayed that UDCA treatment can significantly decrease the ALT levels among the NAFLD patients (SMD=0.17,95%CI [0.03 to 0.3], P=0.07). However, UDCA treatment did not significantly affect the AST, GGT, AP, total bilirubin and albumin levels. Further, the subgroup analyses suggested the significant role of UDCA treatment in different geographical regions, age group and treatment duration (P=0.003 in people from Europe, P=0.001 in people older than 50 years and P=0.008 in longer duration(>6 months)). Conclusion In this study, several indices we analyzed among 9 articles. UDCA treatment was found beneficial in lowering the ALT levels in NAFLD patients. The remaining indices like AST, GGT, AP showed non-significant changes in this analysis. This could be attributed for the insufficient number of trials because all parameters were not analyzed in each individual RCT. Therefore, future meta-analysis will be required to fully confirm and validate the efficacy of UDCA in NAFL.

scholarly journals Impact of remdesivir on 28 day mortality in hospitalized patients with COVID-19: February 2021 Meta-analysis

2021 ◽  
Author(s):  
Robert Robinson ◽  
Vidhya Prakash ◽  
Raad Al Tamimi ◽  
Nour Albast ◽  
Basma Al-Bast ◽  
...  
Keyword(s):  
Usual Care ◽  
English Language ◽  
Meta Analysis ◽  
Severity Of Illness ◽  
Hospitalized Patients ◽  
Randomized Controlled ◽  
Analysis Process ◽  
All Cause Mortality ◽  
The Impact

AbstractBackgroundThe COVID-19 pandemic has stimulated worldwide investigation into a myriad of potential therapeutic agents, including antivirals such as remdesivir. The first RCT reporting results on the impact of remdesivir on COVID-19 in a peer reviewed journal was the ACTT-1 trial published in November, 2020. The ACTT-1 trial showed more rapid clinical improvement and a reduced risk of 28-day mortality in patients who received remdesivir.This study is a meta-analysis of peer reviewed RCTs aims to estimate the association of remdesivir therapy compared to the usual care or placebo on all-cause mortality in hospitalized patients with COVID-19. Software based tools to accelerate the analysis process.MethodsMeta-analysis of peer reviewed RCTs comparing remdesivir to usual care or placebo. The protocol for this meta-analysis was registered and published in the PROSPERO database (CRD42021229985) on February 5, 2021.ResultsFour English language RCTs were identified, including data from 7,333 hospitalized patients worldwide using remdesivir in COVID-19 positive patients.Meta-analysis of all identified RCTs showed no difference in survival in patients who received remdesivir therapy compared to usual care or placebo. The random effects meta-analysis has a summary odd ratio is 0.89 (95% CI 0.65-1.21, p = 0.30). Considerable variability in the severity of illness is noted with the rates of IMV at the time of randomization ranging from 0% to 27%.ConclusionsThis meta-analysis of randomized controlled trials published in peer-reviewed literature by February 1, 2021 did not show reduced mortality in hospitalized patients with COVID-19 who received remdesivir. Further research is needed to clarify the role of remdesivir therapy in the management of COVID-19.

Sign in / Sign up

Export Citation Format

Share Document