tetano
Editor, Senior Moderator
J Infect Dis. 2014 Nov 18. pii: jiu645. [Epub ahead of print]
Effect of corticosteroid therapy on influenza-related mortality: a systematic review and meta-analysis.
Rodrigo C1, Leonardi-Bee J2, Nguyen-Van-Tam JS2, Lim WS1.
Author information
Abstract
BACKGROUND:
Most studies have reported that corticosteroid therapy adversely impacts influenza related outcomes.
METHODS:
Electronic databases were searched from inception to March 2013 for experimental and observational studies investigating systemic corticosteroid therapy for presumed influenza-associated complications. Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were adopted. Pooled odds ratios(ORs) and 95% confidence intervals(CIs) were estimated using random effects models, and heterogeneity was assessed using the I2 statistic. Quality of evidence was assessed using the GRADE (Grading Assessment, Development and Evaluation) system.
RESULTS:
We identified 16 eligible studies (n=3,039 individuals), all observational; 10 (n=1,497 individuals) were included in the meta-analysis of mortality, of which nine studied patients with influenza A(H1N1)pdm09. Risk of bias was greatest in the 'comparability domain' of the Newcastle-Ottowa scale, consistent with potential confounding by indication, and data specific to mortality were of low quality. Meta-analysis found increased odds of mortality (OR 2.12; 95%CI 1.36-3.29) associated with corticosteroid therapy. Sub-group analysis of adjusted estimates from four studies with very low statistical heterogeneity found a similar association (OR 2.58; 95%CI 1.39-4.79).
CONCLUSION:
No completed clinical trials were identified. Evidence from observational studies, with important limitations, suggest that corticosteroid therapy for presumed influenza-associated complications is associated with increased mortality.
? The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
PMID:
25406333
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/25406333
Effect of corticosteroid therapy on influenza-related mortality: a systematic review and meta-analysis.
Rodrigo C1, Leonardi-Bee J2, Nguyen-Van-Tam JS2, Lim WS1.
Author information
Abstract
BACKGROUND:
Most studies have reported that corticosteroid therapy adversely impacts influenza related outcomes.
METHODS:
Electronic databases were searched from inception to March 2013 for experimental and observational studies investigating systemic corticosteroid therapy for presumed influenza-associated complications. Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were adopted. Pooled odds ratios(ORs) and 95% confidence intervals(CIs) were estimated using random effects models, and heterogeneity was assessed using the I2 statistic. Quality of evidence was assessed using the GRADE (Grading Assessment, Development and Evaluation) system.
RESULTS:
We identified 16 eligible studies (n=3,039 individuals), all observational; 10 (n=1,497 individuals) were included in the meta-analysis of mortality, of which nine studied patients with influenza A(H1N1)pdm09. Risk of bias was greatest in the 'comparability domain' of the Newcastle-Ottowa scale, consistent with potential confounding by indication, and data specific to mortality were of low quality. Meta-analysis found increased odds of mortality (OR 2.12; 95%CI 1.36-3.29) associated with corticosteroid therapy. Sub-group analysis of adjusted estimates from four studies with very low statistical heterogeneity found a similar association (OR 2.58; 95%CI 1.39-4.79).
CONCLUSION:
No completed clinical trials were identified. Evidence from observational studies, with important limitations, suggest that corticosteroid therapy for presumed influenza-associated complications is associated with increased mortality.
? The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
PMID:
25406333
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/25406333