Use of corticosteroids in influenza-associated acute respiratory distress syndrome and severe pneumonia: a systemic review and meta-analysis

Abstract

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.

Corticosteroids for patients with acute respiratory distress syndrome: a systematic review and meta-analysis of randomized trials

“…Ventilator -free days up to day 28 The 5 trials (in cluding 771 patients) that examined ventilator free days up to day 28 revealed a significant in crease in the mean number of ventilator free days with corticosteroid treatment (MD, 4.28 days; 95% CI, 2.67-5.88; P <0.001; I 2 = 21%; moderate certainty) (FIGURE 3). The MD was 4.28 (95% CI, 2.67-5.88) more ventilator free days (Supple mentary material, Table S2).…”

Vitamin C and corticosteroids in viral pneumonia: a prospective cohort study

“…(16,17) Current recommendations advise against corticosteroids for in uenza pneumonia, but in critically ill patients on vasopressors, there is a contrary recommendation to suggest steroids for vasopressor refractory shock. (18,19) Vitamin C has been already used in COVID 19 patients requiring mechanical ventilation and studies are underway looking at the combination of Vitamin C and corticosteroids in COVID-19. (20)…”

Pharmacological management of COVID-19 patients with ARDS (CARDS): A narrative review

“…However, the overall evidence scenery, which was mainly influenced by weaker non-randomized observational type studies, was very conflicted. Anyway, a very recent systemic review and meta-analysis on the use of corticosteroids in patients with influenza-related ARDS and severe pneumonia found an association between corticosteroid therapy and increased mortality and incidence of nosocomial infection [ 13 ].…”