Impact of Corticosteroids on Mortality in Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-analysis

• Horita Nobuyuki

  Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Japan Department of Respiratory Medicine, Saiseikai Yokohamashi Nanbu Hospital, Japan

• Hashimoto Satoru

  Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Japan

• Miyazawa Naoki

  Department of Respiratory Medicine, Saiseikai Yokohamashi Nanbu Hospital, Japan

• Fujita Hiroyuki

  Department of Hematology, Saiseikai Yokohamashi Nanbu Hospital, Japan

• Kojima Ryota

  Department of Respiratory Medicine, Saiseikai Yokohamashi Nanbu Hospital, Japan

• Inoue Miyo

  Department of Respiratory Medicine, Saiseikai Yokohamashi Nanbu Hospital, Japan

• Ueda Atsuhisa

  Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Japan

• Ishigatsubo Yoshiaki

  Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Japan

• Kaneko Takeshi

  Respiratory Disease Center, Yokohama City University Medical Center, Japan

抄録

Objective The impact of corticosteroids on acute respiratory distress syndrome (ARDS) mortality remains controversial following the publication of numerous trials, observational studies and meta-analyses. An updated meta-analysis is warranted, as a few original studies on this topic have been published since the last meta-analysis.<br> Methods We searched for eligible articles using four databases. In particular, we included full-length original articles providing sufficient data for evaluating the impact of corticosteroid treatment on adult ARDS mortality in the form of odds ratios. A fixed model with the confidence interval method was used. An assessment of publication bias and sensitivity analyses were also conducted.<br> Results We included 11 of 185 articles. The pooled odds ratio for corticosteroids with respect to all-cause mortality involving 949 patients was 0.77 [95% confidence interval (CI): 0.58-1.03, p=0.079] with strong heterogeneity (I²=70%, p<0.001). The results of the sensitivity analysis, Begg-Kendall test (τ=0.53, p=0.024) and funnel plot consistently suggested the existence of strong publication bias. After six potentially unpublished cohorts were filled using Duval's trim and fill method, the pooled odds ratio shifted to 1.11 (95% CI 0.86-1.44, p=0.427). In addition, the sensitivity analyses suggested that corticosteroid treatment has a different impact on mortality depending on the comorbidities and trigger events.<br> Conclusion We were unable to confirm, based on the data of published studies, the favorable impact of corticosteroid therapy on mortality in overall ARDS cases. Published articles exhibit strong publication bias, and previous meta-analyses may be affected by this publication bias. Further research focusing on pathophysiology- or trigger event-specific ARDS is anticipated.<br>

収録刊行物

• Internal Medicine

  Internal Medicine 54 (12), 1473-1479, 2015

  一般社団法人 日本内科学会

キーワード

• acute lung injury
• prognosis
• corticosteroids
• publication bias

詳細情報

• CRID: 1390001204875145216
• NII論文ID: 130005075938
• DOI: 10.2169/internalmedicine.54.4015
• ISSN: 13497235
• ISSN: 09182918
• Web Site: https://search.jamas.or.jp/link/ui/2016154010
• 本文言語コード: en
• データソース種別:
  • JaLC
  • Crossref
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可