Do corticosteroids reduce the mortality of influenza A (H1N1) infection? A meta-analysis

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• 作者：Yi Zhang (1)
  Wenjie Sun (2) (3)
  Erik R Svendsen (2)
  Song Tang (4)
  Raina C MacIntyre (5)
  Peng Yang (1)
  Daitao Zhang (1)
  Quanyi Wang (1)
  
  1. Beijing Center for Disease Prevention and Control (CDC) ; No. 16 He Pingli Middle Street ; Dongcheng District ; Beijing ; 100013 ; China
  2. School of Public Health and Tropical Medicine ; Tulane University ; 1440 Canal Street ; Suite 2100 ; New Orleans ; LA ; 70112 ; USA
  3. School of Food Science ; Guangdong Pharmaceutical University ; Zhongshan ; 528458 ; China
  4. School of Environment and Sustainability ; University of Saskatchewan ; 44 Campus Drive ; Saskatoon ; SK ; S7N 5B3 ; Canada
  5. School of Public Health and Community Medicine ; The University of New South Wales ; Sydney ; NSW ; 2052 ; Australia
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：1,160 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Corticosteroids are used empirically in influenza A (H1N1) treatment despite lack of clear evidence for effective treatment. This study aims to assess the efficacy of corticosteroids treatment for H1N1 infection. Methods Systematic review and meta-analysis were used to estimate the efficacy of corticosteroids for the prevention of mortality in H1N1 infection. Databases searched included MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Clinical Trials and so on, and bibliographies of retrieved articles, from April 2009 to October 2014. We included both cohort studies and case-control studies reported in English or Chinese that compared treatment effects between corticosteroids and non-corticosteroids therapy in inpatients with H1N1 virus infection. Cohort studies employed mortality as outcome, and case-control studies employed deaths as cases and survivors as controls; both were assessed in this meta-analysis. Results In total twenty-three eligible studies were included. Both cohort studies (nine studies, n鈥?鈥?,405) and case-control studies (14 studies, n鈥?鈥?,700) showed a similar trend toward increased mortality (cohort studies relative risk was 1.85 with 95% confidence interval (CI) 1.46 to 2.33; case-control studies odds ratio was 4.22 with 95% CI 3.10 to 5.76). The results from both subgroup analyses and sensitive analyses were consistent with each other, showing that steroid treatment is associated with mortality. However, considering the fact that corticosteroids were tend to be used in sickest case-patients and heterogeneity was observed between studies, we cannot make a solid conclusion. Conclusions Available evidence did not support the use of corticosteroids as standard care for patients with severe influenza. We conclude that further research is required.