Efficacy and safety of corticosteroids in acute respiratory distress syndrome: An overview of meta‐analyses

Abstract

Background: Evidence-based recommendations on the efficacy and safety of corticosteroids in acute respiratory distress syndrome (ARDS) remain a therapeutic challenge. Findings from several systematic reviews and meta-analyses are inconsistent.We aimed to assess the published meta-analyses through a systematic review approach and provide further insight into the current uncertainty and also to perform an updated meta-analysis from all the available primary studies. Methodology:We followed the Preferred Reporting Items for Systematic Review (PRISMA) guidelines to establish the patients, intervention, control and outcome (PICO) for reviewing published meta-analyses. Data sources such as PubMed/ MEDLINE, SCOPUS, Cochrane and Google Scholar from inception to February 2021 were accessed. Prevention of ARDS, mortality, ventilator-free days, ICU stay and safety in terms of occurrence of adverse effects were the patient-related outcomes.The review also assessed meta-analysis design-related outcomes which includes the quality of meta-analysis, factors contributing to the risk of bias, extent and sources of heterogeneity, publication bias and robustness of findings. AMSTAR-2 checklist assessed the quality of published meta-analyses.Results: A total of 18 meta-analyses were reviewed comprising a total of 38 primary studies and 3760 patients. Fourteen studies were in ARDS, three in communityacquired pneumonia and one in critical care. The overall quality of meta-analyses was observed to be critically low to high. A non-significant risk of publication bias and non-significant level of heterogeneity was observed in the reviewed meta-analysis.Corticosteroid was significantly effective in preventing ARDS among CAP patients.The effect of corticosteroids on mortality was observed to be still inconsistent, whereas significant improvement was observed with ICU and ventilator outcomes compared with the control group. Our meta-analysis observed a significant reduction of mortality in RCTs (RR: 0.78; 95% CI: 0.61 to 0.99) and the duration of mechanical ventilation

Inflammatory bowel disease and COVID-19 outcomes: a meta-analysis

“…The evidence indicates that many other factors, such as the use of biologics 12 , advanced age 11 , 42 , 95 , active IBD status, higher Charlson comorbidity index score 11 , comorbidities, use of corticosteroids 48 , 101 , 112 and thiopurines 101 were significantly associated with COVID-19 mortality in the IBD population. Very recent evidence also indicates a non-significant effect of corticosteroids in mortality among patients with acute respiratory distress syndrome (ARDS), although positive evidence is reported in more recent randomized clinical trials 113 . Hence, the use of corticosteroids needs to be monitored in the general population as well as in IBD patients with COVID-19 or ARDS.…”

Factors affecting the outcomes in patients with acute respiratory distress syndrome in a tertiary care setting

“…Their findings indicate significant mortality reduction in the observations of recent meta-analyses of RCTs, whereas older studies are observed to have a non-significant effect. Moreover, an J o u r n a l P r e -p r o o f updated meta-analysis by the same researchers found a significant mortality reduction in the pooled estimation of RCTs, but not in cohort studies [33].…”