The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis
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Open Access
- 27 March 2019
- journal article
- review article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 23 (1), 1-9
- https://doi.org/10.1186/s13054-019-2395-8
Abstract
The effect of corticosteroids on clinical outcomes in patients with influenza pneumonia remains controversial. We aimed to further evaluate the influence of corticosteroids on mortality in adult patients with influenza pneumonia by comparing corticosteroid-treated and placebo-treated patients. The PubMed, Embase, Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Information Sciences Institute (ISI) Web of Science databases were searched for all controlled studies that compared the effects of corticosteroids and placebo in adult patients with influenza pneumonia. The primary outcome was mortality, and the secondary outcomes were mechanical ventilation (MV) days, length of stay in the intensive care unit (ICU LOS), and the rate of secondary infection. Ten trials involving 6548 patients were pooled in our final analysis. Significant heterogeneity was found in all outcome measures except for ICU LOS (I2 = 38%, P = 0.21). Compared with placebo, corticosteroids were associated with higher mortality (risk ratio [RR] 1.75, 95% confidence interval [CI] 1.30 ~ 2.36, Z = 3.71, P = 0.0002), longer ICU LOS (mean difference [MD] 2.14, 95% CI 1.17 ~ 3.10, Z = 4.35, P < 0.0001), and a higher rate of secondary infection (RR 1.98, 95% CI 1.04 ~ 3.78, Z = 2.08, P = 0.04) but not MV days (MD 0.81, 95% CI − 1.23 ~ 2.84, Z = 0.78, P = 0.44) in patients with influenza pneumonia. In patients with influenza pneumonia, corticosteroid use is associated with higher mortality. PROSPERO (ID: CRD42018112384).Keywords
Funding Information
- Ministry of Science and Technology of the People’s Republic of China (2013BAI09B09)
- the national key Research and Development Program of China (2016YFC1304303)
- Department of Science and Technology of Sichuan Province (2019YFS0033)
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