Effect of glucocorticoids on mortality in patients with acute respiratory distress syndrome: A meta‑analysis

Abstract

To date, the efficacy of glucocorticoid therapy to reduce mortality in patients with acute respiratory distress syndrome (ARDS) has remained controversial among the studies available. The present meta-analysis study aimed to further clarify the impact of glucocorticoid therapy on mortality in patients with ARDS by performing a pooled analysis of the previous data. The PubMed, Chinese Knowledge Infrastructure, Wanfang and Cochrane trials databases were searched for relevant studies published between 1966 and 2016. Randomized controlled trials (RCTs) that included the use of glucocorticoids in patients with ARDS and had reported on mortality were included. Odds ratios (OR) and 95% confidence intervals (CI) for mortality were calculated. A total of 10 RCTs were included in the meta-analysis. Of these, 4 studies used high-dose glucocorticoid therapy, while 6 used low-dose glucocorticoid therapy. In the pooled analysis, glucocorticoids were indicated to significantly reduce ARDS-associated mortality (OR= 0.64, 95% CI: 0.48-0.85, P= 0.002). Further subgroup analysis indicated the following: i) Long-term low-dose glucocorticoid therapy reduced ARDS-associated mortality compared with that in the control group (OR=0.60, 95% CI: 0.44-0.82, P= 0.001), whereas high-dose short-term glucocorticoid therapy did not reduce mortality (OR= 0.82, 95% CI: 0.43-1.57, P= 0.55). ii) Early initiation of glucocorticoid therapy was associated with reduced mortality compared with that in the control group (OR= 0.60, 95% CI: 0.44-0.83, P= 0.002); however, late initiation did not reduce mortality (OR=0.36, 95% CI: 0.03-3.76, P=0.39). iii) Therapeutic rather than preventive use of glucocorticoids reduced mortality (OR= 0.65, 95% CI: 0.49-0.86, P= 0.003). Overall, the present meta-analysis suggests that early initiation of long-term low-dose glucocorticoid therapy reduces mortality of patients with ARDS.

Decreased mortality in acute respiratory distress syndrome patients treated with corticosteroids: an updated meta-analysis of randomized clinical trials with trial sequential analysis

“…Besides, this study also indicated that glucocorticoid treatment was not associated with a higher incidence of new infection and hyperglycemia. Several systematic reviews and meta-analyses on the topic had been presented [9,[26][27][28][29]. Among previous meta-analyses, Zayed, Y.…”

Dexamethasone in the era of COVID-19: friend or foe? An essay on the effects of dexamethasone and the potential risks of its inadvertent use in patients with diabetes

“…The use of hydrocortisone at a dose of 200 mg per day would be indicated only for refractory cases, but with a weak recommendation [71]. The controversial results also apply to the use of corticosteroids in patients with acute respiratory distress syndrome, on which different meta-analyses carried out in recent years have presented divergent results, making this difficult to value for clinical practice [72][73][74][75]. So far, the use of corticosteroids in critically ill patients, regardless of etiology, remains restricted to cases in which there is refractoriness in shock or in which the ventilatory pattern reflects bronchial hyperreactivity [76].…”

The Role of Glucocorticoids in the Management of COVID-19

“…A meta-analysis, which included the Dexa-ARDS trial, as well as others, also favored the use of glucocorticoids in ARDS, although some reservations remained regarding the reliability of the findings 65 . Additionally, a recent meta-analysis attempted to dissect the issues of timing and dosing of glucocorticoid use in ARDS and came to the conclusion that early initiation of glucocorticoid therapy and use of a low to medium dose were associated with lower mortality 66 . Overall, the issue of glucocorticoid use in ARDS is still not entirely resolved, however, recent evidence has tipped the balance in favor of glucocorticoid treatment with a recommendation for early commencement of steroids at a low to medium dose.…”