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Meta-Analysis
. 2019 Mar 27;23(1):99.
doi: 10.1186/s13054-019-2395-8.

The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis

Yue-Nan Ni  1 , Guo Chen  2 , Jiankui Sun  3 , Bin-Miao Liang  4 , Zong-An Liang  1
Affiliations
Meta-Analysis

The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis

Yue-Nan Ni et al. Crit Care. .

Erratum in

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: In patients with influenza pneumonia, corticosteroid use is associated with higher mortality.

Trial registration: PROSPERO (ID: CRD42018112384 ).

Keywords: Corticosteroids; Influenza pneumonia; Mortality.

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Conflict of interest statement

Ethics approval and consent to participate

Each enrolled trial was approved by the corresponding institutional ethical committee, and all participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Effect of corticosteroids on mortality. CI, confidence interval; RR, risk ratio
Fig. 3
Fig. 3
Subgroup analysis of the effect of corticosteroids on mortality in patients with H1N1. Diamonds indicate overall estimates from the meta-analysis; squares indicate point estimates of the result of each study; horizontal lines represent 95% CI. CI, confidence interval; RR, risk ratio
Fig. 4
Fig. 4
Effect of corticosteroids on MV days. Diamonds indicate overall estimates from the meta-analysis; squares indicate point estimates of the result of each study; horizontal lines represent 95% CI. CI, confidence interval; MV, mechanical ventilation; MD, mean difference
Fig. 5
Fig. 5
Effect of corticosteroids on ICU LOS. Diamonds indicate overall estimates from the meta-analysis; squares indicate point estimates of the result of each study; horizontal lines represent 95% CI. CI, confidence interval; ICU, intensive care unit; LOS, length of stay; MD, mean difference
Fig. 6
Fig. 6
Effect of corticosteroids on the rate of secondary infection. Diamonds indicate overall estimates from the meta-analysis; squares indicate point estimates of the result of each study; horizontal lines represent 95% CI. CI, confidence interval; RR, risk ratio
See this image and copyright information in PMC

Comment in

References

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