Department of Intensive Care Unit, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, 136#, Zhongshan Er Road, Yuzhong, Chongqing, 400014, China.
Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Respir Res. 2022 Nov 4;23(1):301. doi: 10.1186/s12931-022-02186-4.
Acute respiratory distress syndrome (ARDS) is an acute and critical disease among children and adults, and previous studies have shown that the administration of corticosteroids remains controversial. Therefore, a meta-analysis of randomized controlled trials (RCTs) was performed to evaluate the safety and efficacy of corticosteroids.
The RCTs investigating the safety and efficacy of corticosteroids in ARDS were searched from electronic databases (Embase, Medline, and the Cochrane Central Register of Controlled Trials). The primary outcome was 28-day mortality. Heterogeneity was assessed using the Chi square test and I with the inspection level of 0.1 and 50%, respectively.
Fourteen RCTs (n = 1607) were included for analysis. Corticosteroids were found to reduce the risk of death in patients with ARDS (relative risk (RR) = 0.78, 95% confidence interval (CI): 0.70-0.87; P < 0.01). Moreover, no significant adverse events were observed, compared to placebo or standard support therapy. Further subgroup analysis showed that variables, such as adults (RR = 0.78; 95% CI: 0.70-0.88; P < 0.01), non-COVID-19 (RR = 0.71; 95% CI: 0.62-0.83; P < 0.01), methylprednisolone (RR = 0.70; 95% CI: 0.56-0.88; P < 0.01), and hydrocortisone (RR = 0.79; 95% CI: 0.63-0.98; P = 0.03) were associated with 28-day mortality among patients who used corticosteroids. However, no association was found, regarding children (RR = 0.21; 95% CI: 0.01-4.10; P = 0.30).
The use of corticosteroids is an effective approach to reduce the risk of death in ARDS patients. However, this effect is associated with age, non-COVID-19 diseases, and methylprednisolone and hydrocortisone use. Therefore, evidence suggests patients with age ≥ 18 years and non-COVID-19 should be encouraged during the corticosteroid treatment. However, due to substantial differences in the use of corticosteroids among these studies, questions still remain regarding the dosage, optimal corticosteroid agent, and treatment duration in patients with ARDS.
急性呼吸窘迫综合征（ARDS）是儿童和成人中的一种急性危重症疾病，既往研究表明皮质类固醇的应用仍存在争议。因此，我们进行了一项荟萃分析，以评估皮质类固醇治疗 ARDS 的安全性和疗效。
我们从电子数据库（Embase、Medline 和 Cochrane 对照试验中心注册库）中检索了评估皮质类固醇治疗 ARDS 的安全性和疗效的随机对照试验（RCT）。主要结局为 28 天死亡率。采用卡方检验评估异质性，并用 I ²检验评估异质性程度，检验水准分别为 0.1 和 50%。
共纳入 14 项 RCT（n=1607）进行分析。皮质类固醇可降低 ARDS 患者的死亡风险（相对风险（RR）=0.78，95%置信区间（CI）：0.70-0.87；P<0.01）。与安慰剂或标准支持治疗相比，皮质类固醇并未增加不良反应。进一步的亚组分析显示，成人（RR=0.78；95%CI：0.70-0.88；P<0.01）、非 COVID-19（RR=0.71；95%CI：0.62-0.83；P<0.01）、甲泼尼龙（RR=0.70；95%CI：0.56-0.88；P<0.01）和氢化可的松（RR=0.79；95%CI：0.63-0.98；P=0.03）患者使用皮质类固醇与 28 天死亡率降低相关。然而，皮质类固醇对儿童（RR=0.21；95%CI：0.01-4.10；P=0.30）的 28 天死亡率无影响。
皮质类固醇的应用可有效降低 ARDS 患者的死亡风险。然而，这种效果与年龄、非 COVID-19 疾病以及甲泼尼龙和氢化可的松的应用相关。因此，有证据表明应鼓励年龄≥18 岁和非 COVID-19 的患者进行皮质类固醇治疗。但是，由于这些研究中皮质类固醇的使用存在较大差异，关于 ARDS 患者的皮质类固醇剂量、最佳皮质类固醇药物和治疗持续时间等问题仍有待解决。
