Corticosteroids for treating dengue shock syndrome

Abstract

Background: Dengue shock syndrome is the most severe from of dengue haemorrhagic fever, one of the leading causes of death in children. Observational studies have suggested corticosteroids may benefit people with dengue shock syndrome.

Objectives: To compare corticosteroids with placebo or no corticosteroids for treating dengue shock syndrome.

Search strategy: We searched the Cochrane Infectious Disease Group Specialized Register (January 2006), CENTRAL (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to January 2006), EMBASE, (1974 to January 2006), LILACS (1982 to January 2006), and reference lists. We also contacted researchers.

Selection criteria: Randomized and quasi-randomized controlled trials comparing corticosteroids with no corticosteroids or placebo in people diagnosed with dengue shock syndrome.

Data collection and analysis: Two authors independently applied the inclusion criteria, extracted data, and assessed methodological quality. We calculated the relative risk (RR) for dichotomous data and weighted mean difference for continuous data, and presented them with 95% confidence intervals (CI).

Main results: Four trials involving 284 participants met the inclusion criteria. Corticosteroids were no more effective than placebo or no treatment for reducing the number of deaths (RR 0.68, 95% CI 0.42 to 1.11; 284 participants, 4 trials), the need for blood transfusion (RR 1.08, 0.52 to 2.24; 89 participants, 2 trials), or the number of serious complications (convulsions and pulmonary haemorrhage) as reported in one trial (63 participants).

Authors' conclusions: There is insufficient evidence to justify the use of corticosteroids in managing dengue shock syndrome. As corticosteroids can potentially do harm, clinicians should not use them unless they are participating in a randomized controlled trial comparing corticosteroids with placebo.