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Influenza-related severe pneumonia and acute respiratory distress syndrome (ARDS) are severe threats to human health. The objective of this study was to assess the effects of systematic corticosteroid therapy in patients with pneumonia or ARDS. The PubMed, EMBASE, Web of Science and SCOPUS databases were searched up to July, 2019. Nineteen studies including 6637 individuals were identified, and fifteen studies (6427 patients) were included in the meta-analysis of mortality. Eighteen were observational studies and one was a randomized controlled trial (RCT). The meta-analysis results showed that corticosteroid therapy was associated with significantly higher mortality (OR 1.53, 95% CI [1.16, 2.01]) and incidence of nosocomial infection (OR 3.15, 95% CI [1.54, 6.45]). Subgroup analysis showed that among patients with unadjusted estimates, the odds of mortality were higher in patients receiving corticosteroid treatment (OR 1.98, 95% CI [1.23, 3.17]), however, among patients with adjusted estimates, the result showed no statistically significant difference between corticosteroid group and control group (OR 1.31, 95% CI [0.95, 1.80]). Current data do not support the routine use of corticosteroids in patients with influenza severe pneumonia or ARDS. RCTs are needed to provide more robust evidence. MethodsStudy eligibility criteria. This systematic review included studies fulfilling the following inclusion criteria: (a) the studies were RCTs, quasi-experimental studies, or observational studies; (b) patients had confirmed influenza-related pneumonia, ARDS (PaO 2 /FiO 2 < 300 mmHg); (c) the intervention group used corticosteroids, and the comparison group did not, with no restriction set on the dose or duration of the intervention; and (d) the outcomes were mortality, nosocomial infection, length of stay or other clinical outcomes. A study was excluded if it met any of the following criteria: (a) the study was a review article, conference abstract, case report or case series, case-control study; (b) the majority of included patients were immunocompromised; (c) insufficient data were available; (d) overlapping population; (e) studies with fewer than 20 participants. There were no restrictions on influenza subtype, patient age or study setting. If only some of the individuals included in a study fit the eligibility criteria and these individuals had extractable results corresponding to the objective of this study, then the study was included.Clinical outcomes including mortality, nosocomial infection, duration of mechanical ventilation, length of stay, time to fever alleviation and clinical stability and viral shedding were evaluated. Scientific RepoRtS |(2020) 10:3044 | https://doi.

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The role of asymptomatic infections in the transmission of COVID-19 have drawn considerable attention. Here, we performed a meta-analysis to summarize the epidemiological and radiographical characteristics of asymptomatic infections associated with COVID-19. Methods: Data on the epidemiological and radiographical characteristics of asymptomatic infections were extracted from the existing literature. Pooled proportions with 95% confidence intervals were then calculated using a random effects model. Results: A total of 104 studies involving 20,152 cases were included. The proportion of asymptomatic individuals among those with COVID-19 was 13.34% (10.86%-16.29%), among which presymptomatic and covert infections accounted for 7.64% (4.02%-14.04%) and 8.44% (5.12%-13.62%), respectively. The proportions of asymptomatic infections among infected children and healthcare workers were 32.24% (23.08%-42.13%) and 36.96% (18.51%-60.21%), respectively. The proportion of asymptomatic infections was significantly higher after 2020/02/29 than before (33.53% vs 10.19%) and in non-Asian regions than in Asia (28.76% vs 11.54%). The median viral shedding duration of asymptomatic infections was 14.14 days (11.25-17.04). A total of 47.62% (31.13%-72.87%) of asymptomatic infections showed lung abnormalities, especially ground-glass opacity (41.11% 19.7%-85.79%). Conclusions: Asymptomatic infections were more commonly found in infected children and healthcare workers and increased after 2020/02/29 and in non-Asian regions. Chest radiographical imaging could be conducive to the early identification of asymptomatic infections.

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