TY - JOUR
T1 - Efficacy and safety of low-dose corticosteroids for acute respiratory distress syndrome
T2 - A systematic review and meta-analysis
AU - Cui, Yu Qing
AU - Ding, Xian Fei
AU - Liang, Huo Yan
AU - Wang, Dong
AU - Zhang, Xiao Juan
AU - Li, Li Feng
AU - Kan, Quan Cheng
AU - Wang, Le Xin
AU - Sun, Tong Wen
N1 - Publisher Copyright:
© 2021 World Journal of Emergency Medicine.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: There are conflicting results
regarding whether corticosteroids have better efficacy than placebo in
acute respiratory distress syndrome (ARDS) patients. Therefore, we aim
to further evaluate the efficacy and safety of corticosteroids in adult
ARDS patients. METHODS: The
databases, including Medline, EMBASE, and Cochrane Central Register of
Controlled Trials (CENTRAL) in the Cochrane Library, were searched from
their inception to May 2, 2020. Randomized controlled trials (RCTs) and
observational cohort studies were selected to assess the use of
corticosteroids in adult ARDS patients. The quality of the results was
judged by the Grading of Recommendations Assessment, Development, and
Evaluation (GRADE) methodology. The inverse-variance method with random
or fixed effects modeling was used to compute pooled odds ratio (OR), standardized mean difference (SMD), and their 95% confidence interval (CI). RESULTS: Eight eligible RCTs and six cohort studies were included. The use of corticosteroids was associated with reduced mortality (OR 0.57, 95% CI 0.43-0.76, I2=35.1%, P=0.148) in ARDS patients, and the result was confirmed in the included cohort studies (OR 0.51, 95% CI 0.27-0.95, I2=66.7%, P=0.010).
The subgroup analysis stratified by the initiation time and duration of
corticosteroid use showed that early ARDS and prolonged corticosteroid
use had significant survival benefits in the RCTs. The low-dose
corticosteroid use was also associated with significantly more
ventilator-free days and a reduced rate of new infections in ARDS
patients. CONCLUSIONS: The low-dose
corticosteroid therapy may be safe and reduce mortality, especially in
patients with prolonged treatment and early ARDS.
AB - BACKGROUND: There are conflicting results
regarding whether corticosteroids have better efficacy than placebo in
acute respiratory distress syndrome (ARDS) patients. Therefore, we aim
to further evaluate the efficacy and safety of corticosteroids in adult
ARDS patients. METHODS: The
databases, including Medline, EMBASE, and Cochrane Central Register of
Controlled Trials (CENTRAL) in the Cochrane Library, were searched from
their inception to May 2, 2020. Randomized controlled trials (RCTs) and
observational cohort studies were selected to assess the use of
corticosteroids in adult ARDS patients. The quality of the results was
judged by the Grading of Recommendations Assessment, Development, and
Evaluation (GRADE) methodology. The inverse-variance method with random
or fixed effects modeling was used to compute pooled odds ratio (OR), standardized mean difference (SMD), and their 95% confidence interval (CI). RESULTS: Eight eligible RCTs and six cohort studies were included. The use of corticosteroids was associated with reduced mortality (OR 0.57, 95% CI 0.43-0.76, I2=35.1%, P=0.148) in ARDS patients, and the result was confirmed in the included cohort studies (OR 0.51, 95% CI 0.27-0.95, I2=66.7%, P=0.010).
The subgroup analysis stratified by the initiation time and duration of
corticosteroid use showed that early ARDS and prolonged corticosteroid
use had significant survival benefits in the RCTs. The low-dose
corticosteroid use was also associated with significantly more
ventilator-free days and a reduced rate of new infections in ARDS
patients. CONCLUSIONS: The low-dose
corticosteroid therapy may be safe and reduce mortality, especially in
patients with prolonged treatment and early ARDS.
KW - Acute respiratory distress syndrome
KW - Corticosteroid
KW - Low-dose
KW - Meta-analysis
KW - Mortality
KW - Systematic review
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U2 - 10.5847/WJEM.J.1920-8642.2021.03.008
DO - 10.5847/WJEM.J.1920-8642.2021.03.008
M3 - Review article
AN - SCOPUS:85113910376
VL - 12
SP - 207
EP - 213
JO - World Journal of Emergency Medicine
JF - World Journal of Emergency Medicine
SN - 1920-8642
IS - 3
ER -