Corticosteroid treatment for early acute respiratory distress syndrome: a systematic review and meta-analysis of randomi
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RESEARCH
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Corticosteroid treatment for early acute respiratory distress syndrome: a systematic review and meta-analysis of randomized trials Yohei Hirano* , Shunsuke Madokoro, Yutaka Kondo, Ken Okamoto and Hiroshi Tanaka
Abstract Background: The effect of corticosteroid treatment on survival outcome in early acute respiratory distress syndrome (ARDS) is still debated. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of prolonged corticosteroid therapy in early ARDS. Methods: We assessed the MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases from inception to August 1, 2020. We included RCTs that compared prolonged corticosteroid therapy with control treatment wherein the intervention was started within 72 h of ARDS diagnosis. Two investigators independently screened the citations and conducted the data extraction. The primary outcomes were all-cause 28- or 30-day mortality and 60-day mortality. Several endpoints such as ventilator-free days and adverse events were set as the secondary outcomes. DerSimonian-Laird random-effects models were used to report pooled odds ratios (ORs). Results: Among the 4 RCTs included, all referred to the all-cause 28- or 30-day mortality. In the corticosteroid group, 108 of 385 patients (28.1%) died, while 139 of 357 (38.9%) died in the control group (pooled OR, 0.61; 95% confidence interval [CI], 0.44–0.85). Three RCTs mentioned the all-cause 60-day mortality. In the corticosteroid group, 78 of 300 patients (26.0%) died, while 101 of 265 (38.1%) died in the control group (pooled OR, 0.57; 95% CI, 0.40–0.83). For secondary outcomes, corticosteroid treatment versus control significantly prolonged the ventilator-free days (4 RCTs: mean difference, 3.74; 95% CI, 1.53–5.95) but caused hyperglycemia (3 RCTs: pooled OR, 1.52; 95% CI, 1.04–2.21). Conclusions: Prolonged corticosteroid treatment in early ARDS improved the survival outcomes. Trial registration: PROSPERO, CRD42020195969 Keywords: Corticosteroids, Acute respiratory distress syndrome, Systematic reviews, Meta-analysis
Background Acute respiratory distress syndrome (ARDS) is characterized by an acute diffuse, inflammatory lung injury with an increased alveolar-capillary permeability and loss of aerated lung tissue, contributing to impaired oxygenation [1]. ARDS is a challenging disease for practitioners * Correspondence: [email protected] Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan
in intensive care due to the lack of effective therapeutics and its high mortality rate. As ARDS is an inflammatory syndrome, antiinflammatory drugs including corticosteroids might serve as potential therapeutics for ARDS. Until now, there have been a number of randomized controlled studies conducted to assess the efficacy of corticosteroids on ARDS [2–7]. However, its effectiveness on patient survival is still controversial.
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