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Effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: A meta-analysis

While previous trials have indicated that the use of corticosteroids for patients with acute respiratory distress syndrome (ARDS) is effective, the dosage and time-course for the use of corticosteroids remain a subject of controversy. The present study aimed to address and resolve these problems. Pu...

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Autores principales: Sun, Shuangshuang, Liu, Dadong, Zhang, Hao, Zhang, Xiuwei, Wan, Bing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: D.A. Spandidos 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878884/
https://www.ncbi.nlm.nih.gov/pubmed/31807150
http://dx.doi.org/10.3892/etm.2019.8167
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author Sun, Shuangshuang
Liu, Dadong
Zhang, Hao
Zhang, Xiuwei
Wan, Bing
author_facet Sun, Shuangshuang
Liu, Dadong
Zhang, Hao
Zhang, Xiuwei
Wan, Bing
author_sort Sun, Shuangshuang
collection PubMed
description While previous trials have indicated that the use of corticosteroids for patients with acute respiratory distress syndrome (ARDS) is effective, the dosage and time-course for the use of corticosteroids remain a subject of controversy. The present study aimed to address and resolve these problems. PubMed, Embase and the Cochrane Library databases were searched from inception to March 2017 for randomized controlled trials (RCTs), which included patients with ARDS using corticosteroids. Related data were extracted independently by two investigators. The Mantel-Haenszel method was used with random-effects modeling to calculate the pooled odds ratio (OR) and 95% confidence interval (CI) for the mortality of patients with ARDS, and the risk of new infection arising from the use of glucocorticoids. The inverse variance method was used to calculate the mean difference (MD) and 95% CI for the duration of mechanical-free ventilation and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO(2)/FIO(2) ratio). The use of low-dose corticosteroids significantly reduced the mortality rate of patients with ARDS (OR: 0.43; 95% CI: 0.24–0.79; P=0.006) while the use of high-dose corticosteroids provided no significant benefit to reducing the mortality rate (OR: 1.33; 95% CI: 0.86–2.04; P=0.20). The present study identified that glucocorticoids reduced the mortality rate of patients during the early stages of ARDS (OR: 0.61; 95% CI: 0.43–0.86; P=0.005). Glucocorticoids significantly reduced the duration of mechanical ventilation (MD: 3.08; 95% CI: 1.49–4.68; P<0.05) and significantly improved the PaO(2)/FiO(2) ratio (MD: 66.39; 95% CI: 57.79–74.98; P<0.05). The use of corticosteroids did not significantly increase the rate of infectious complications (OR: 0.60; 95% CI: 0.32–1.12; P>0.05). The use of low-dose corticosteroids may significantly reduce the mortality rate, particularly in the early stages of ARD, shorten the duration of mechanical ventilation and improve the PaO(2)/FiO(2) ratio without increasing the risk of a new infection.
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spelling pubmed-68788842019-12-05 Effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: A meta-analysis Sun, Shuangshuang Liu, Dadong Zhang, Hao Zhang, Xiuwei Wan, Bing Exp Ther Med Articles While previous trials have indicated that the use of corticosteroids for patients with acute respiratory distress syndrome (ARDS) is effective, the dosage and time-course for the use of corticosteroids remain a subject of controversy. The present study aimed to address and resolve these problems. PubMed, Embase and the Cochrane Library databases were searched from inception to March 2017 for randomized controlled trials (RCTs), which included patients with ARDS using corticosteroids. Related data were extracted independently by two investigators. The Mantel-Haenszel method was used with random-effects modeling to calculate the pooled odds ratio (OR) and 95% confidence interval (CI) for the mortality of patients with ARDS, and the risk of new infection arising from the use of glucocorticoids. The inverse variance method was used to calculate the mean difference (MD) and 95% CI for the duration of mechanical-free ventilation and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO(2)/FIO(2) ratio). The use of low-dose corticosteroids significantly reduced the mortality rate of patients with ARDS (OR: 0.43; 95% CI: 0.24–0.79; P=0.006) while the use of high-dose corticosteroids provided no significant benefit to reducing the mortality rate (OR: 1.33; 95% CI: 0.86–2.04; P=0.20). The present study identified that glucocorticoids reduced the mortality rate of patients during the early stages of ARDS (OR: 0.61; 95% CI: 0.43–0.86; P=0.005). Glucocorticoids significantly reduced the duration of mechanical ventilation (MD: 3.08; 95% CI: 1.49–4.68; P<0.05) and significantly improved the PaO(2)/FiO(2) ratio (MD: 66.39; 95% CI: 57.79–74.98; P<0.05). The use of corticosteroids did not significantly increase the rate of infectious complications (OR: 0.60; 95% CI: 0.32–1.12; P>0.05). The use of low-dose corticosteroids may significantly reduce the mortality rate, particularly in the early stages of ARD, shorten the duration of mechanical ventilation and improve the PaO(2)/FiO(2) ratio without increasing the risk of a new infection. D.A. Spandidos 2019-12 2019-11-04 /pmc/articles/PMC6878884/ /pubmed/31807150 http://dx.doi.org/10.3892/etm.2019.8167 Text en Copyright: © Sun et al. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
spellingShingle Articles
Sun, Shuangshuang
Liu, Dadong
Zhang, Hao
Zhang, Xiuwei
Wan, Bing
Effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: A meta-analysis
title Effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: A meta-analysis
title_full Effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: A meta-analysis
title_fullStr Effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: A meta-analysis
title_full_unstemmed Effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: A meta-analysis
title_short Effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: A meta-analysis
title_sort effect of different doses and time-courses of corticosteroid treatment in patients with acute respiratory distress syndrome: a meta-analysis
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878884/
https://www.ncbi.nlm.nih.gov/pubmed/31807150
http://dx.doi.org/10.3892/etm.2019.8167
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