Effect of Corticosteroid Therapy on Influenza-Related Mortality: A Systematic Review and Meta-analysis

Rodrigo, Chamira; Leonardi-Bee, Jo; Nguyen-Van-Tam, Jonathan S.; Lim, Wei Shen

Abstract

Background: Most studies have reported that corticosteroid therapy adversely influences 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 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 Grading Assessment, Development, and Evaluation system.

Results: We identified 16 eligible studies (3039 individuals), all of which were observational; 10 (1497 individuals) were included in the meta-analysis of mortality, of which 9 studied patients with 2009 pandemic influenza A virus subtype H1N1. Risk of bias was greatest in the comparability domain of the Newcastle–Ottawa scale, consistent with potential confounding by indication, and data specific to mortality were of low quality. Meta-analysis found an increased odds of mortality (OR, 2.12; 95% CI, 1.36–3.29) associated with corticosteroid therapy. Subgroup analysis of adjusted estimates from 4 studies with very low statistical heterogeneity found a similar association (OR, 2.58; 95% CI, 1.39–4.79).

Conclusions: No completed clinical trials were identified. Evidence from observational studies, with important limitations, suggests that corticosteroid therapy for presumed influenza-associated complications is associated with increased mortality.

Citation

Rodrigo, C., Leonardi-Bee, J., Nguyen-Van-Tam, J. S., & Lim, W. S. (2015). Effect of Corticosteroid Therapy on Influenza-Related Mortality: A Systematic Review and Meta-analysis. Journal of Infectious Diseases, 212(2), 183-194. https://doi.org/10.1093/infdis/jiu645

• Journal Article Type: Article
• Acceptance Date: Nov 6, 2014
• Online Publication Date: Nov 18, 2014
• Publication Date: Jul 15, 2015
• Deposit Date: Mar 31, 2017
• Publicly Available Date: Mar 31, 2017
• Journal: Journal of Infectious Diseases
• Print ISSN: 0022-1899
• Electronic ISSN: 1537-6613
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 212
• Issue: 2
• Pages: 183-194
• DOI: https://doi.org/10.1093/infdis/jiu645
• Keywords: influenza; corticosteroid
• Public URL: https://nottingham-repository.worktribe.com/output/756984
• Publisher URL: https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jiu645
• Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of Infectious Diseases following peer review. The version of record Chamira Rodrigo, Jo Leonardi-Bee, Jonathan S. Nguyen-Van-Tam, Wei Shen Lim; Effect of Corticosteroid Therapy on Influenza-Related Mortality: A Systematic Review and Meta-analysis. J Infect Dis 2015; 212 (2): 183-194 is available online at: https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jiu645