Zolfaghari, ParjamAlGhamdi, Shouq2023-10-292023-10-292023-10-23https://hdl.handle.net/20.500.14154/69495Background: Patients infected with COVID-19 may experience an overwhelming inflammatory response due to a delay in the activation of their immune system, which allows the virus more time to replicate. Suppression of the inflammatory responses during the early stages of the disease can be achieved with various drugs, however, the RECOVERY trial demonstrated a mortality-related benefit when administrating dexamethasone to the infected population. Thus, the role of the dose and timing of corticosteroid therapy was investigated by many researchers, yet there is no available systematic review to assess their effect on clinical outcomes. Therefore, this review evaluated the effect of corticosteroid timing and dosage on clinical outcomes among COVID-19 infected patients. Method: This systematic review was done according to the Preferred Reporting in Systematic Reviews and Meta-Analyses guidelines. The studies were identified by searching the following electronic databases, Embase, OVID Medline, and ScienceDirect. Results: The search strategies generated a total of 35876 matches; of these 44 studies met the eligibility criteria. Three studies reported a significant association between 28-day mortality and high-dose corticosteroids. Controversial results were observed concerning MV use across studies, as it was related to early initiation time in one study, while linked to late initiation in another. Moreover, the need for MV therapy was associated with the high-dose groups in three studies, however, one study contradicted this result with less MV use being reported within the same group. Four studies reported higher odds of developing infectious complications within the high-dose groups. Hyperglycaemia was significantly associated with high-dose corticosteroid therapy in four studies and linked to early initiation time in one study. Data on hospital LOS showed a significantly shorter stay associated with low-dose therapy in three studies and to no-corticosteroid therapy in two studies. Early initiation was linked with shorter ICU stay in two studies, and to shorter time to ICU discharge in one study. Adverse events were common, with significant associations reported in five studies, were the majority linked the development of complications to the use of high-dose corticosteroid therapy. There was no significant difference in relation to tracheostomy rates, and data on rehabilitation were not available in all included studies. Conclusion: The controversy remains, and future studies should focus their work on assessing the effect of both the time and the dose of corticosteroid therapy on clinical outcomes among hospitalised COVID-19 patients.49enSevere acute respiratory syndrome coronavirus 2corticosteroidscoronavirus disease 2019Thesis