Effects of methyl prednisolone in early ARDS

Rezk, Nasef Abd-Elsalam; Ibrahim, Amer M.

doi:10.1016/j.ejcdt.2013.02.013

Cited by 58 publications

(49 citation statements)

References 9 publications

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“…Furthermore, we noted significant het erogeneity in the pooled estimates of mechanical ventilation times. We could not explain the dif ferences by any methodological or overt clinical heterogeneity between the 5 studies, except for the outlier study by Rezk and Ibrahim, 16 which dif fered from other studies with regard to numerous outcomes, examined the smallest patient sample, reported on the least duration of mechanical ven tilation, and was at high risk of biased estimates. The exploration of heterogeneity was limited due to the suboptimal reporting overall.…”

Section: Infectionsmentioning

confidence: 82%

“…We conducted a sensitivity analysis by exclud ing studies at high risk of bias. 16,17,20 The mor tality benefit associated with the use of corti costeroids was robust and consistent (RR, 0.77; 95% CI, 0.61-0.98; P = 0.03). The subgroup test of of the domains was not reported to be optimal ly handled, then we considered the study as hav ing a high risk of bias.…”

Section: Study Characteristicsmentioning

confidence: 94%

“…Primary studies were con ducted in multiple countries (China, Egypt, Ku wait, Spain, Thailand, and the United States), with 43% of them being multicenter trials. Al most all the studies were funded by nonprof it organizations, except for the study by Zhao et al, 16 whose funding source was uncertain. Sam ple sizes ranged from 26 to 277 hospitalized pa tients, mostly men (51.5%-85.2%) and typical ly over 50 years of age.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Patients received cortico steroid treatment with hydrocortisone, 17,18 meth ylprednisolone, 5,16,19 dexamethasone, 4 or inhaled budesonide. A placebo was used in 5 studies, 5, [16][17][18][19] and 2 studies 4,20 compared the typical manage ment of ARDS with and without corticosteroids. Follow up ranged from 28 to 180 days from en rollment.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Corticosteroids for patients with acute respiratory distress syndrome: a systematic review and meta-analysis of randomized trials

Mammen

Aryal

Alhazzani

et al. 2020

Polish Archives of Internal Medicine

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Section: Infectionsmentioning

confidence: 82%

Section: Study Characteristicsmentioning

confidence: 94%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Corticosteroids for patients with acute respiratory distress syndrome: a systematic review and meta-analysis of randomized trials

Mammen

Aryal

Alhazzani

et al. 2020

Polish Archives of Internal Medicine

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“…Some evidence points towards a beneficial effect of corticosteroids in ARDS. 12,[14][15][16] Recently Villar et al 17 showed that early therapy with dexamethasone could reduce the duration of mechanical ventilation and the overall mortality in patients with established moderate-to-severe ARDS, possibly because early administration could have an effect on the systemic immune response involved in ARDS pathophysiology. Some evidence casts doubts on the appropriateness of corticosteroid therapy: a large multicenter randomized clinical trial 18 showed no benefit in ARDS and found an increased risk of mortality when treatment began late in the course of the disease.…”

Section: Discussionmentioning

confidence: 99%

Effect of corticosteroid treatment on 1376 hospitalized COVID-19 patients. A cohort study.

Albani

Fusina

Granato

et al. 2020

Preprint

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Background: Since the start of the novel coronavirus 2019 (COVID-19) pandemic, corticosteroid use has been the subject of debate. The available evidence is uncertain, and knowledge on the subject is evolving. The aim of our cohort study was to evaluate the association between corticosteroid therapy and hospital mortality, in patients hospitalized with COVID-19 after balancing for possible confounders. Results: One thousand four hundred forty four patients were admitted to our hospital with a positive RT-PCR test for SARS-CoV-2, 559 patients (39%) were exposed to corticosteroids during hospital stay, 844 (61%) were not exposed to corticosteroids.In the cohort of patients exposed to corticosteroids, 171 (30.6%) died. In the cohort of patients not exposed to corticosteroids, 183 (21.7%) died (unadjusted p <0.001). Nonetheless, exposure to corticosteroids was not associated with in-hospital mortality after balancing with overlap weight propensity score (adjusted p = 0.25). Patients in the corticosteroids cohort had reduced risk of ICU admission (adjusted p <0.001). Conclusions: Treatment with corticosteroids did not affect hospital mortality in patients with COVID-19 after balancing for confounders. A possible advantage of corticosteroid therapy was to reduce Intensive Care Unit admission, which could be useful in reducing pressure on the Intensive Care Units in times of limited resources, as during the COVID-19 pandemic.

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Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis

et al. 2019

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IMPORTANCEAlthough corticosteroids are widely used for adults with sepsis, both the overall benefit and potential risks remain unclear.OBJECTIVE To conduct a systematic review and meta-analysis of the efficacy and safety of corticosteroids in patients with sepsis. DATA SOURCES AND STUDY SELECTION MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception until March 20, 2018, and updated on August 10, 2018. The terms corticosteroids, sepsis, septic shock, hydrocortisone, controlled trials, and randomized controlled trial were searched alone or in combination. Randomized clinical trials (RCTs) were included that compared administration of corticosteroids with placebo or standard supportive care in adults with sepsis.DATA EXTRACTION AND SYNTHESIS Meta-analyses were conducted using a random-effects model to calculate risk ratios (RRs) and mean differences (MDs) with corresponding 95% CIs. Two independent reviewers completed citation screening, data abstraction, and risk assessment. MAIN OUTCOMES AND MEASURES Twenty-eight-day mortality.RESULTS This meta-analysis included 37 RCTs (N = 9564 patients). Eleven trials were rated as low risk of bias. Corticosteroid use was associated with reduced 28-day mortality (RR, 0.90; 95% CI, 0.82-0.98; I 2 = 27%) and intensive care unit (ICU) mortality (RR, 0.85; 95% CI, 0.77-0.94; I 2 = 0%) and in-hospital mortality (RR, 0.88; 95% CI, 0.79-0.99; I 2 = 38%). Corticosteroids were significantly associated with increased shock reversal at day 7 (MD, 1.95; 95% CI, 0.80-3.11) and vasopressor-free days (MD, 1.95; 95% CI, 0.80-3.11) and with ICU length of stay (MD, −1.16; 95% CI, −2.12 to −0.20), the sequential organ failure assessment score at day 7 (MD, −1.38; 95% CI, −1.87 to −0.89), and time to resolution of shock (MD, −1.35; 95% CI, −1.78 to −0.91). However, corticosteroid use was associated with increased risk of hyperglycemia (RR, 1.19; 95% CI, 1.08-1.30) and hypernatremia (RR, 1.57; 95% CI, 1.24-1.99). CONCLUSIONS AND RELEVANCEThe findings suggest that administration of corticosteroids is associated with reduced 28-day mortality compared with placebo use or standard supportive care. More research is needed to associate personalized medicine with the corticosteroid treatment to select suitable patients who are more likely to show a benefit.

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Effects of methyl prednisolone in early ARDS

Cited by 58 publications

References 9 publications

Corticosteroids for patients with acute respiratory distress syndrome: a systematic review and meta-analysis of randomized trials

Corticosteroids for patients with acute respiratory distress syndrome: a systematic review and meta-analysis of randomized trials

Effect of corticosteroid treatment on 1376 hospitalized COVID-19 patients. A cohort study.

Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis

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