Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot3 - STU 1 ballot
Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot3 - STU 1 ballot
Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot3 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ebm/ and changes regularly. See the Directory of published versions
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<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Citation 105</b></p><a name="105"> </a><a name="hc105"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">version: 22; Last updated: 2025-10-13 12:34:35+0000</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-journal-article-citation.html">JournalArticleCitation</a></p></div><p><b>ArtifactPublicationStatus</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-status-type active}">Active</span></p><p><b>url</b>: <a href="https://fevir.net/resources/Citation/105">https://fevir.net/resources/Citation/105</a></p><p><b>identifier</b>: FEvIR Object Identifier/105, <code>https://pubmed.ncbi.nlm.nih.gov</code>/33008778</p><p><b>title</b>: 33008778 Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis.</p><p><b>status</b>: Active</p><p><b>author</b>: Computable Publishing®: MEDLINE-to-FEvIR Converter: </p><p><b>publisher</b>: Computable Publishing LLC</p><p><b>contact</b>: <a href="mailto:support@computablepublishing.com">support@computablepublishing.com</a></p><p><b>description</b>: </p><div><p>This Citation Resource is referenced in an example for the EBMonFHIR Implementation Guide.</p>
</div><h3>UseContexts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td><a href="http://terminology.hl7.org/7.1.0/CodeSystem-citation-classification-type.html#citation-classification-type-fevir-platform-use">Citation Classification Type: fevir-platform-use</a> (FEvIR Platform Use)</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/citation-artifact-classifier medline-base}">Medline Base</span></td></tr></table><p><b>copyright</b>: </p><div><p>https://creativecommons.org/licenses/by-nc-sa/4.0/</p>
</div><p><b>approvalDate</b>: 2020-11-16</p><p><b>lastReviewDate</b>: 2023-11-12</p><blockquote><p><b>classification</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/citation-classification-type citation-source}">Citation Source</span></p><p><b>classifier</b>: <span title="Codes:">MEDLINE</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/citation-classification-type medline-owner}">MEDLINE Citation Owner</span></p><p><b>classifier</b>: <span title="Codes:{https://www.nlm.nih.gov/bsd/licensee/elements_descriptions.html#owner_value NLM}">National Library of Medicine, Index Section</span></p></blockquote><p><b>currentState</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type medline-medline}">Medline Citation Status of Medline</span>, <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-publication-status-ppublish}">PubMed PublicationStatus of ppublish</span></p><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-received}">PubMed Pubstatus of Received</span></p><p><b>period</b>: ?? --> 2020-08-13</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-revised}">PubMed Pubstatus of Revised</span></p><p><b>period</b>: ?? --> 2020-09-14</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-accepted}">PubMed Pubstatus of Accepted</span></p><p><b>period</b>: ?? --> 2020-09-16</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-pubmed}">PubMed Pubstatus of Pubmed</span></p><p><b>period</b>: ?? --> 2020-10-04 06:00:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-medline}">PubMed Pubstatus of Medline</span></p><p><b>period</b>: ?? --> 2020-11-18 06:00:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-entrez}">PubMed Pubstatus of Entrez</span></p><p><b>period</b>: ?? --> 2020-10-03 05:25:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title="Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-pmc-release}">PubMed Pubstatus of PMC release</span></p><p><b>period</b>: ?? --> 2020-09-29</p></blockquote><blockquote><p><b>citedArtifact</b></p><p><b>identifier</b>: <code>https://pubmed.ncbi.nlm.nih.gov</code>/33008778, <code>https://www.ncbi.nlm.nih.gov/pmc/</code>/PMC7522674, <code>https://doi.org</code>/10.1016/j.jiph.2020.09.008, pii/S1876-0341(20)30663-8</p><h3>Titles</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Text</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/title-type primary}">Primary title</span></td><td><div><p>Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis.</p>
</div></td></tr></table><h3>Abstracts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Text</b></td><td><b>Copyright</b></td></tr><tr><td style="display: none">*</td><td><div><p><strong>BACKGROUND:</strong> To systematically review the literature about the association between systemic corticosteroid therapy (CST) and outcomes of COVID-19 patients.
<strong>METHODS:</strong> We searched Medline, Embase, EBM Reviews, Scopus, Web of Science, and preprints up to July 20, 2020. We included observational studies and randomized controlled trials (RCT) that assessed COVID-19 patients treated with CST. We pooled adjusted effect estimates of mortality and other outcomes using a random effect model, among studies at low or moderate risk for bias. We assessed the certainty of evidence for each outcome using the GRADE approach.
<strong>RESULTS:</strong> Out of 1067 citations screened for eligibility, one RCT and 19 cohort studies were included (16,977 hospitalized patients). Ten studies (1 RCT and 9 cohorts) with 10,278 patients examined the effect of CST on short term mortality. The pooled adjusted RR was 0.92 (95% CI 0.69-1.22, I<sup>2</sup> = 81.94%). This effect was observed across all stages of disease severity. Four cohort studies examined the effect of CST on composite outcome of death, ICU admission and mechanical ventilation need. The pooled adjusted RR was 0.41(0.23-0.73, I<sup>2</sup> = 78.69%). Six cohort studies examined the effect of CST on delayed viral clearance. The pooled adjusted RR was 1.47(95% CI 1.11-1.93, I<sup>2</sup> = 43.38%).
<strong>CONCLUSION:</strong> In this systematic review, as of July 2020, heterogeneous and low certainty cumulative evidence based on observational studies and one RCT suggests that CST was not associated with reduction in short-term mortality but possibly with a delay in viral clearance in patients hospitalized with COVID-19 of different severities. However, the discordant results between the single RCT and observational studies as well as the heterogeneity observed across observational studies, call for caution in using observational data and suggests the need for more RCTs to identify the clinical and biochemical characteristics of patients' population that could benefit from CST.</p>
</div></td><td><div><p>Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.</p>
</div></td></tr></table><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Chen G., Wu D., Guo W., Cao Y., Huang D., Wang H. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020;130(5):2620–2629.</p>
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</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/18538991/">https://pubmed.ncbi.nlm.nih.gov/18538991/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>citation</b>: </p><div><p>Horby P., Lim W.S., Emberson J., Mafham M., Bell J., Linsell L. Effect of dexamethasone in hospitalized patients with COVID-19: preliminary report. medRxiv. 2020 2020.06.22.20137273.</p>
</div></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Cao C., Chen M., Li Y., Yu L., Huang W., Qian G. Clinical features and predictors for patients with severe SARS-CoV-2 pneumonia: a retrospective multicenter cohort study. medRxiv. 2020 2020.06.01.20119032.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/34238240/">https://pubmed.ncbi.nlm.nih.gov/34238240/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Chen X., Zhu B., Hong W., Zeng J., He X., Chen J. Associations of clinical characteristics and treatment regimens with viral RNA shedding duration in patients with COVID-19. Int J Infect Dis. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32619760/">https://pubmed.ncbi.nlm.nih.gov/32619760/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Chroboczek T., Lacoste M., Wackenheim C., Challan-Belval T., Amar B., Boisson T. Corticosteroids in patients with COVID-19: what about the control group? Clin Infect Dis. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32548616/">https://pubmed.ncbi.nlm.nih.gov/32548616/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Corral L., Bahamonde A., Arnaiz delas Revillas F., Gomez-Barquero J., Abadia-Otero J., Garcia-Ibarbia C. GLUCOCOVID: a controlled trial of methylprednisolone in adults hospitalized with COVID-19 pneumonia. medRxiv. 2020 2020.06.17.20133579.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/33534047/">https://pubmed.ncbi.nlm.nih.gov/33534047/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>citation</b>: </p><div><p>Crotty M.P., Akins R.L., Nguyen A.T., Slika R., Rahmanzadeh K., Wilson M.H. Investigation of subsequent and co-infections associated with SARS-CoV-2 (COVID-19) in hospitalized patients. medRxiv. 2020 2020.05.29.20117176.</p>
</div></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Fadel R., Morrison A.R., Vahia A., Smith Z.R., Chaudhry Z., Bhargava P. Early short course corticosteroids in hospitalized patients with COVID-19. Clin Infect Dis. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32427279/">https://pubmed.ncbi.nlm.nih.gov/32427279/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Fernández Cruz A., Ruiz-Antorán B., Muñoz Gómez A., Sancho López A., Mills Sánchez P., Centeno Soto G.A. Impact of glucocorticoid treatment in SARS-CoV-2 infection mortality: a retrospective controlled cohort study. Antimicrob Agents Chemother. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32571831/">https://pubmed.ncbi.nlm.nih.gov/32571831/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Giacobbe D.R., Battaglini D., Ball L., Brunetti I., Bruzzone B., Codda G. Bloodstream infections in critically ill patients with COVID-19. Eur J Clin Invest. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32535894/">https://pubmed.ncbi.nlm.nih.gov/32535894/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Li X., Xu S., Yu M., Wang K., Tao Y., Zhou Y. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32294485/">https://pubmed.ncbi.nlm.nih.gov/32294485/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Lu X., Chen T., Wang Y., Wang J., Yan F. Adjuvant corticosteroid therapy for critically ill patients with COVID-19. Crit Care. 2020;24(1):241.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32430057/">https://pubmed.ncbi.nlm.nih.gov/32430057/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Majmundar M., Kansara T., Lenik J.M., Park H., Ghosh K., Doshi R. Efficacy of corticosteroids in non-intensive care unit patients with COVID-19 pneumonia from the New York Metropolitan region. medRxiv. 2020 2020.07.02.20145565.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32903258/">https://pubmed.ncbi.nlm.nih.gov/32903258/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>citation</b>: </p><div><p>Mengyuan Liang P.C., He Miao. 2020. Corticosteroid treatment in critically ill patients with COVID-19: a retrospective cohort study.</p>
</div></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>citation</b>: </p><div><p>Narain S., Stefanov D., Chau A.S., Weber A.G., Marder G.S., Kaplan B. Comparative survival analysis of immunomodulatory therapy for COVID-19 ‘cytokine storm’: a retrospective observational cohort study. medRxiv. 2020 2020.06.16.20126714.</p>
</div></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Petrak R., Skorodin N., Van Hise N., Fliegelman R., Pinsky J., Didwania V. Tocilizumab as a therapeutic agent for critically ill patients infected with SARS-CoV-2. medRxiv. 2020 2020.06.05.20122622.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32918792/">https://pubmed.ncbi.nlm.nih.gov/32918792/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Qi L., Yang Y., Jiang D., Tu C., Wan L., Chen X. Factors associated with duration of viral shedding in adults with COVID-19 outside of Wuhan, China: a retrospective cohort study. Int J Infect Dis. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32425636/">https://pubmed.ncbi.nlm.nih.gov/32425636/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Salton F., Confalonieri P., Santus P., Harari S., Scala R., Lanini S. Prolonged low-dose methylprednisolone in patients with severe COVID-19 pneumonia. medRxiv. 2020 2020.06.17.20134031.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/33072814/">https://pubmed.ncbi.nlm.nih.gov/33072814/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Shi D., Wu W., Wang Q., Xu K., Xie J., Wu J. Clinical characteristics and factors associated with long-term viral excretion in patients with SARS-CoV-2 infection: a single center 28-day study. J Infect Dis. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32614392/">https://pubmed.ncbi.nlm.nih.gov/32614392/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>citation</b>: </p><div><p>Wang D., Wang J., Jiang Q., Yang J., Li J., Gao C. No clear benefit to the use of corticosteroid as treatment in adult patients with Coronavirus Disease 2019: a retrospective cohort study. medRxiv. 2020 2020.04.21.20066258.</p>
</div></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Wang K., Zhang X., Sun J., Ye J., Wang F., Hua J. Differences of SARS-CoV-2 shedding duration in sputum and nasopharyngeal swab specimens among adult inpatients with COVID-19. Chest. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32569635/">https://pubmed.ncbi.nlm.nih.gov/32569635/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>citation</b>: </p><div><p>Wu J., Huang J., Zhu G., Liu Y., Xiao H., Zhou Q. Systemic corticosteroids show no benefit in severe and critical COVID-19 patients in Wuhan, China: a retrospective cohort study. medRxiv. 2020 2020.05.11.20097709.</p>
</div></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Xu K., Chen Y., Yuan J., Yi P., Ding C., Wu W. Factors associated with prolonged viral RNA shedding in patients with coronavirus disease 2019 (COVID-19) Clin Infect Dis. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32271376/">https://pubmed.ncbi.nlm.nih.gov/32271376/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Li T.-Z., Cao Z.-H., Chen Y., Cai M.-T., Zhang L.-Y., Xu H., Zhang L.-Y., Ma C.-H., Li T.-Z., Gao L.-J. Duration of SARS-CoV-2 RNA shedding and factors associated with prolonged viral shedding in patients with COVID-19. J Med Virol. 2020;(July) doi: 10.1002/jmv.26280.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32644223/">https://pubmed.ncbi.nlm.nih.gov/32644223/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>citation</b>: </p><div><p>Albani F., Fusina F., Granato E., Capotosto C., Ceracchi C., Gargaruti R. Effect of corticosteroid treatment on 1376 hospitalized COVID-19 patients. A cohort study. medRxiv. 2020 2020.07.17.20155994.</p>
</div></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Booth C.M., Tannock I.F. Randomised controlled trials and population-based observational research: partners in the evolution of medical evidence. Br J Cancer. 2014;110(3):551–555.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/24495873/">https://pubmed.ncbi.nlm.nih.gov/24495873/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Ni Y.N., Chen G., Sun J., Liang B.M., Liang Z.A. The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis. Crit Care. 2019;23(1):99.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/30917856/">https://pubmed.ncbi.nlm.nih.gov/30917856/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Siemieniuk R.A., Meade M.O., Alonso-Coello P., Briel M., Evaniew N., Prasad M. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: a systematic review and meta-analysis. Ann Intern Med. 2015;163(7):519–528.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/26258555/">https://pubmed.ncbi.nlm.nih.gov/26258555/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Lucas C., Wong P., Klein J., Castro T.B.R., Silva J., Sundaram M. Longitudinal analyses reveal immunological misfiring in severe COVID-19. Nature. 2020</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32717743/">https://pubmed.ncbi.nlm.nih.gov/32717743/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Carsana L., Sonzogni A., Nasr A., Rossi R.S., Pellegrinelli A., Zerbi P., Rech R., Colombo R., Antinori S., Corbellino M. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. Lancet Infect Dis. 2020;20:1135–1140.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32526193/">https://pubmed.ncbi.nlm.nih.gov/32526193/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Rapkiewicz A.V., Mai X., Carsons S.E., Pittaluga S., Kleiner D.E., Berger J.S. Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: a case series. EClinicalMedicine. 2020;24</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32766543/">https://pubmed.ncbi.nlm.nih.gov/32766543/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Gattinoni L., Chiumello D., Caironi P., Busana M., Romitti F., Brazzi L. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099–1102.</p>
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</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/26584195/">https://pubmed.ncbi.nlm.nih.gov/26584195/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Lansbury L.E., Rodrigo C., Leonardi-Bee J., Nguyen-Van-Tam J., Lim W.S. Corticosteroids as adjunctive therapy in the treatment of influenza: an updated Cochrane systematic review and meta-analysis. Crit Care Med. 2019</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/31939808/">https://pubmed.ncbi.nlm.nih.gov/31939808/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Tang B.M., Craig J.C., Eslick G.D., Seppelt I., McLean A.S. Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med. 2009;37(5):1594–1603.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/19325471/">https://pubmed.ncbi.nlm.nih.gov/19325471/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>To K.K., Tsang O.T., Leung W.S., Tam A.R., Wu T.C., Lung D.C. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020;20(5):565–574.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/32213337/">https://pubmed.ncbi.nlm.nih.gov/32213337/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Lee N., Chan P.K., Hui D.S., Rainer T.H., Wong E., Choi K.W. Viral loads and duration of viral shedding in adult patients hospitalized with influenza. J Infect Dis. 2009;200(4):492–500.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/19591575/">https://pubmed.ncbi.nlm.nih.gov/19591575/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Wolkewitz M., Schumacher M. Survival biases lead to flawed conclusions in observational treatment studies of influenza patients. J Clin Epidemiol. 2017;84:121–129.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/28188897/">https://pubmed.ncbi.nlm.nih.gov/28188897/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Cites</p><p><b>classifier</b>: <span title="Codes:{http://hl7.org/fhir/citation-artifact-classifier D016428}">Journal Article</span></p><p><b>citation</b>: </p><div><p>Fewell Z., Davey Smith G., Sterne J.A. The impact of residual and unmeasured confounding in epidemiologic studies: a simulation study. Am J Epidemiol. 2007;166(6):646–655.</p>
</div><p><b>target</b>: <a href="https://pubmed.ncbi.nlm.nih.gov/17615092/">https://pubmed.ncbi.nlm.nih.gov/17615092/</a></p></blockquote><blockquote><p><b>publicationForm</b></p><blockquote><p><b>publishedIn</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/published-in-type D020492}">Periodical</span></p><p><b>identifier</b>: Electronic ISSN Type/1876-035X, ISOAbbreviation/J Infect Public Health, ISSN Linking/1876-0341, Medline Title Abbreviation/J Infect Public Health, NLM Unique ID/101487384</p><p><b>title</b>: Journal of infection and public health</p><p><b>publisherLocation</b>: England</p></blockquote><p><b>citedMedium</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cited-medium internet}">Internet</span></p><p><b>volume</b>: 13</p><p><b>issue</b>: 11</p><p><b>articleDate</b>: 2020-11</p><p><b>pageString</b>: 1652-1663</p></blockquote><blockquote><p><b>publicationForm</b></p><p><b>citedMedium</b>: <span 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**METHODS:** We searched Medline, Embase, EBM Reviews, Scopus, Web of Science, and preprints up to July 20, 2020. We included observational studies and randomized controlled trials (RCT) that assessed COVID-19 patients treated with CST. We pooled adjusted effect estimates of mortality and other outcomes using a random effect model, among studies at low or moderate risk for bias. We assessed the certainty of evidence for each outcome using the GRADE approach.
**RESULTS:** Out of 1067 citations screened for eligibility, one RCT and 19 cohort studies were included (16,977 hospitalized patients). Ten studies (1 RCT and 9 cohorts) with 10,278 patients examined the effect of CST on short term mortality. The pooled adjusted RR was 0.92 (95% CI 0.69-1.22, I<sup>2</sup> = 81.94%). This effect was observed across all stages of disease severity. Four cohort studies examined the effect of CST on composite outcome of death, ICU admission and mechanical ventilation need. The pooled adjusted RR was 0.41(0.23-0.73, I<sup>2</sup> = 78.69%). Six cohort studies examined the effect of CST on delayed viral clearance. The pooled adjusted RR was 1.47(95% CI 1.11-1.93, I<sup>2</sup> = 43.38%).
**CONCLUSION:** In this systematic review, as of July 2020, heterogeneous and low certainty cumulative evidence based on observational studies and one RCT suggests that CST was not associated with reduction in short-term mortality but possibly with a delay in viral clearance in patients hospitalized with COVID-19 of different severities. However, the discordant results between the single RCT and observational studies as well as the heterogeneity observed across observational studies, call for caution in using observational data and suggests the need for more RCTs to identify the clinical and biochemical characteristics of patients' population that could benefit from CST."/>
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value="College of Medicine, Al Faisal University, Riyadh, Saudi Arabia; Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address: Tleyjeh.Imad@mayo.edu."/>
</affiliation>
</entry>
</contributorship>
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</Citation>
IG © 2024+ HL7 International / Clinical Decision Support.
Package hl7.fhir.uv.ebm#1.0.0-ballot3 based on FHIR 6.0.0-ballot3.
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2026-06-12
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