Cargando…
Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies
BACKGROUND: Evidence supporting corticosteroids adjunctive treatment (CAT) for Pneumocystis jirovecii pneumonia (PCP) in non-HIV patients is highly controversial. We aimed to systematically review the literature and perform a meta-analysis of available data relating to the effect of CAT on mortality...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083987/ https://www.ncbi.nlm.nih.gov/pubmed/32198645 http://dx.doi.org/10.1186/s13613-020-00649-9 |
_version_ | 1783508637748035584 |
---|---|
author | Ding, Lin Huang, Huixue Wang, Heyan He, Hangyong |
author_facet | Ding, Lin Huang, Huixue Wang, Heyan He, Hangyong |
author_sort | Ding, Lin |
collection | PubMed |
description | BACKGROUND: Evidence supporting corticosteroids adjunctive treatment (CAT) for Pneumocystis jirovecii pneumonia (PCP) in non-HIV patients is highly controversial. We aimed to systematically review the literature and perform a meta-analysis of available data relating to the effect of CAT on mortality of PCP in non-HIV patients. METHODS: We searched Pubmed, Medline, Embase, and Cochrane database from 1989 through 2019. Data on clinical outcomes from non-HIV PCP were extracted with a standardized instrument. Heterogeneity was assessed with the I(2) index. Pooled odds ratios and 95% confidence interval were calculated using a fixed effects model. We analyzed the impact of CAT on mortality of non-HIV PCP in the whole PCP population, those who had hypoxemia (PaO(2) < 70 mmHg) and who had respiratory failure (PaO(2) < 60 mmHg). RESULTS: In total, 259 articles were identified, and 2518 cases from 16 retrospective observational studies were included. In all non-HIV PCP cases included, there was an association between CAT and increased mortality (odds ratio, 1.37; 95% confidence interval 1.07–1.75; P = 0.01). CAT showed a probable benefit of decreasing mortality in hypoxemic non-HIV PCP patients (odds ratio, 0.69; 95% confidence interval 0.47–1.01; P = 0.05). Furthermore, in a subgroup analysis, CAT showed a significantly lower mortality in non-HIV PCP patients with respiratory failure compared to no CAT (odds ratio, 0.63; 95% confidence interval 0.41–0.95; P = 0.03). CONCLUSIONS: Our meta-analysis suggests that among non-HIV PCP patients with respiratory failure, CAT use may be associated with better clinical outcomes, and it may be associated with increased mortality in unselected non-HIV PCP population. Clinical trials are needed to compare CAT vs no-CAT in non-HIV PCP patients with respiratory failure. Furthermore, CAT use should be withheld in non-HIV PCP patients without hypoxemia. |
format | Online Article Text |
id | pubmed-7083987 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-70839872020-03-23 Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies Ding, Lin Huang, Huixue Wang, Heyan He, Hangyong Ann Intensive Care Research BACKGROUND: Evidence supporting corticosteroids adjunctive treatment (CAT) for Pneumocystis jirovecii pneumonia (PCP) in non-HIV patients is highly controversial. We aimed to systematically review the literature and perform a meta-analysis of available data relating to the effect of CAT on mortality of PCP in non-HIV patients. METHODS: We searched Pubmed, Medline, Embase, and Cochrane database from 1989 through 2019. Data on clinical outcomes from non-HIV PCP were extracted with a standardized instrument. Heterogeneity was assessed with the I(2) index. Pooled odds ratios and 95% confidence interval were calculated using a fixed effects model. We analyzed the impact of CAT on mortality of non-HIV PCP in the whole PCP population, those who had hypoxemia (PaO(2) < 70 mmHg) and who had respiratory failure (PaO(2) < 60 mmHg). RESULTS: In total, 259 articles were identified, and 2518 cases from 16 retrospective observational studies were included. In all non-HIV PCP cases included, there was an association between CAT and increased mortality (odds ratio, 1.37; 95% confidence interval 1.07–1.75; P = 0.01). CAT showed a probable benefit of decreasing mortality in hypoxemic non-HIV PCP patients (odds ratio, 0.69; 95% confidence interval 0.47–1.01; P = 0.05). Furthermore, in a subgroup analysis, CAT showed a significantly lower mortality in non-HIV PCP patients with respiratory failure compared to no CAT (odds ratio, 0.63; 95% confidence interval 0.41–0.95; P = 0.03). CONCLUSIONS: Our meta-analysis suggests that among non-HIV PCP patients with respiratory failure, CAT use may be associated with better clinical outcomes, and it may be associated with increased mortality in unselected non-HIV PCP population. Clinical trials are needed to compare CAT vs no-CAT in non-HIV PCP patients with respiratory failure. Furthermore, CAT use should be withheld in non-HIV PCP patients without hypoxemia. Springer International Publishing 2020-03-20 /pmc/articles/PMC7083987/ /pubmed/32198645 http://dx.doi.org/10.1186/s13613-020-00649-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Research Ding, Lin Huang, Huixue Wang, Heyan He, Hangyong Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies |
title | Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies |
title_full | Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies |
title_fullStr | Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies |
title_full_unstemmed | Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies |
title_short | Adjunctive corticosteroids may be associated with better outcome for non-HIV Pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies |
title_sort | adjunctive corticosteroids may be associated with better outcome for non-hiv pneumocystis pneumonia with respiratory failure: a systemic review and meta-analysis of observational studies |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083987/ https://www.ncbi.nlm.nih.gov/pubmed/32198645 http://dx.doi.org/10.1186/s13613-020-00649-9 |
work_keys_str_mv | AT dinglin adjunctivecorticosteroidsmaybeassociatedwithbetteroutcomefornonhivpneumocystispneumoniawithrespiratoryfailureasystemicreviewandmetaanalysisofobservationalstudies AT huanghuixue adjunctivecorticosteroidsmaybeassociatedwithbetteroutcomefornonhivpneumocystispneumoniawithrespiratoryfailureasystemicreviewandmetaanalysisofobservationalstudies AT wangheyan adjunctivecorticosteroidsmaybeassociatedwithbetteroutcomefornonhivpneumocystispneumoniawithrespiratoryfailureasystemicreviewandmetaanalysisofobservationalstudies AT hehangyong adjunctivecorticosteroidsmaybeassociatedwithbetteroutcomefornonhivpneumocystispneumoniawithrespiratoryfailureasystemicreviewandmetaanalysisofobservationalstudies |