Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
Department of Geriatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.
Crit Care. 2019 Mar 27;23(1):99. doi: 10.1186/s13054-019-2395-8.
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 (I = 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 ).
皮质类固醇对流感肺炎患者临床结局的影响仍存在争议。我们旨在通过比较皮质类固醇治疗和安慰剂治疗的患者，进一步评估皮质类固醇对成人流感肺炎患者死亡率的影响。
检索 PubMed、Embase、Medline、Cochrane 中央对照试验注册库（CENTRAL）和信息科学研究所（ISI）Web of Science 数据库，以查找比较皮质类固醇和安慰剂在成人流感肺炎患者中疗效的所有对照研究。主要结局是死亡率，次要结局是机械通气（MV）天数、重症监护病房（ICU）住院时间和继发感染率。
共有 10 项涉及 6548 例患者的试验纳入最终分析。除 ICU 住院时间（I = 38%，P = 0.21）外，所有结局指标均存在显著异质性。与安慰剂相比，皮质类固醇与更高的死亡率相关（风险比 [RR] 1.75，95%置信区间 [CI] 1.302.36，Z = 3.71，P = 0.0002）、更长的 ICU 住院时间（均数差 [MD] 2.14，95% CI 1.173.10，Z = 4.35，P < 0.0001）和更高的继发感染率（RR 1.98，95% CI 1.043.78，Z = 2.08，P = 0.04），但机械通气时间（MD 0.81，95% CI -1.232.84，Z = 0.78，P = 0.44）并无差异。
在流感肺炎患者中，皮质类固醇的使用与死亡率升高相关。
PROSPERO（ID：CRD42018112384）。
