Abstract
IntroductionCorticosteroids are used empirically in influenza A (H1N1) treatment despite lack of clear evidence for effective treatment. This study aims to assess the efficacy of corticosteroids treatment for H1N1 infection.MethodsSystematic review and meta-analysis were used to estimate the efficacy of corticosteroids for the prevention of mortality in H1N1 infection. Databases searched included MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Clinical Trials and so on, and bibliographies of retrieved articles, from April 2009 to October 2014. We included both cohort studies and case-control studies reported in English or Chinese that compared treatment effects between corticosteroids and non-corticosteroids therapy in inpatients with H1N1 virus infection. Cohort studies employed mortality as outcome, and case-control studies employed deaths as cases and survivors as controls; both were assessed in this meta-analysis.ResultsIn total twenty-three eligible studies were included. Both cohort studies (nine studies, n = 1,405) and case-control studies (14 studies, n = 4,700) showed a similar trend toward increased mortality (cohort studies relative risk was 1.85 with 95% confidence interval (CI) 1.46 to 2.33; case-control studies odds ratio was 4.22 with 95% CI 3.10 to 5.76). The results from both subgroup analyses and sensitive analyses were consistent with each other, showing that steroid treatment is associated with mortality. However, considering the fact that corticosteroids were tend to be used in sickest case-patients and heterogeneity was observed between studies, we cannot make a solid conclusion.ConclusionsAvailable evidence did not support the use of corticosteroids as standard care for patients with severe influenza. We conclude that further research is required.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0764-5) contains supplementary material, which is available to authorized users.
Highlights
Corticosteroids are used empirically in influenza A (H1N1) treatment despite lack of clear evidence for effective treatment
To clarify the association of corticosteroids with H1N1 mortality taking into account clinical status and study design, we examined the associations in larger, prospective cohort studies in global settings, using existing literature, and assessed the effect of corticosteroids treatment on mortality through metaanalysis
Seven studies were conducted in China [36,39,41,42,43,44,50], three in Spain [33,45,49], three in India [31,35,46], two in Korea [18,28], two in Argentina [15,40], and one study each was conducted in Mexico [37], Turkey [38], Saudi Arabia [48], France [51], and Finland [52], while the remaining study was multicenter and conducted in several countries (European Society of Intensive Care Medicine) [47]
Summary
Corticosteroids are used empirically in influenza A (H1N1) treatment despite lack of clear evidence for effective treatment. This study aims to assess the efficacy of corticosteroids treatment for H1N1 infection. Novel influenza A (H1N1) spread around the world in spring 2009. Influenza A (H1N1) infection has a mild clinical course, the pandemic virus is capable of leading to severe illness, requiring hospitalization. The hospital admission rate for children with 2009 H1N1 influenza was twofold the rate for seasonal influenza [1]. Approximately 9 to 31% of hospitalized patients were admitted to an ICU, where 14 to 46% of patients died [2,3,4,5]. There is an increasing need for the development of an effective
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