Introduction
Methods
Search strategy and selection criteria
Eligibility criteria
Data extraction
Qualitative assessment
Statistical analysis
Role of the funding source
Results
Study characteristics
First author, year
|
Country
|
Study design
|
Population
|
Sample size
|
Mean/median age (years)
|
Female (
n
/%)
|
Antiviral
|
Corticosteroid doses and duration
|
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Rios, 2011 [15] | Argentina | Case–control | Confirmed influenza A (H1N1) and ARDS and mechanical ventilation and ICU | 178 | 44 | 98/55.0 | Treatment with oseltamivir was given to 98% of patients, with 60% receiving 300 mg/day. The frequency of use and doses were similar in both survivors and nonsurvivors | Corticosteroids were prescribed in 36% of patients for septic shock as 300 mg/day hydrocortisone |
Chawla, 2013 [31] | India | Case–control | Confirmed influenza A (H1N1) cases and inpatient | 77 | 40.88 | 33/42.9 | No statistical difference between two groups | Steroids were administered for an average duration of 10.61 days |
Hong, 2013 [32] | South Korea | Case–control | Confirmed influenza A (H1N1) cases and critical illnesses and adult | 245 | 55.3 | 111/45.3 | All patients received antiviral therapy | Dose equivalent (prednisolone) 75 mg/day |
Jose, 2013 [33] | Spain | Case–control | Confirmed influenza A (H1N1) cases and requiring ICU admission and age ≥15 years | 1,120 | 72 | 365/32.6 | Not comparable between two groups (more dead patients use antiviral after 48 hours after hospital admission) | Corticosteroid use was not standardized and was decided by the attending physician |
Jung, 2011 [34] | South Korea | Case–control | Confirmed influenza A (H1N1) cases and critical illnesses and requiring ICU admission and age ≥15 years | 221 | 57 | 103/46.6 | All patients received antiviral treatment, and the duration from symptom onset to initial antiviral treatment did not differ | No mentioned |
Kinikar, 2012 [35] | India | Case–control | Confirmed influenza A (H1N1) cases and inpatient or admitted to the ICU and children | 92 | 2.5 | 49/53.0 | All patients received antiviral treatment | Short course of corticosteroids was administered to 21 children |
Li, 2012 [36] | China | Case–control | Confirmed influenza A (H1N1) case sand critical illnesses and children and inpatient | 1,137 | 4 | 390/34.3 | Not comparable between two groups (more survival patients use antiviral within 48 hours of onset of illness) | Median duration of corticosteroids treatment was 6 days |
Perez-Padilla, 2009 [37] | Mexico | Case–control | Confirmed influenza A (H1N1) cases and inpatient and pneumonia | 18 | 38 | 9/50.0 | None of the patients were given oseltamivir during the first 48 hours after the onset of symptoms | Corticosteroids were administered at the discretion of the attending physicians. Hydrocortisone at a dose of 300 mg/day or methylprednisolone at a dose of 60 mg/day |
Sertogullarindan, 2011 [38] | Turkey | Case–control | Confirmed influenza A (H1N1) cases and requiring ICU admission and pneumonia | 20 | 36 | 10/50.0 | None of them had taken oseltamivir within 48 hours. Overall, patients received oseltamivir therapy at a dosage of 75 mg twice a day for 5 days | Not mentioned |
Sun, 2010 [39] | China | Case–control | Confirmed influenza A (H1N1) cases and ICU | 18 | 37 | 8/44.4 | Oseltamivir 150 mg, twice daily | Methylprednisolone: 3 to 5 days, 1 to 2 mg/kg; or hydrocortisone 300 mg/day |
Torres, 2012 [40] | Argentina | Case–control | Confirmed influenza A (H1N1) and pediatric ICU | 142 | 19 months | 86/60.0 | All patients were treated with oseltamivir | No mentioned |
Xi, 2010 [41] | China | Case–control | Confirmed influenza A (H1N1) cases and adult and inpatient | 155 | 43 | 65/41.9 | No statistical difference between two groups | There were 33.5% patients treated with systemic corticosteroids, daily dose of corticosteroids ranged from methylprednisolone 12 to 320 mg (or equivalent dose), with a median dose of 80 mg |
Yu, 2011 [42] | China | Case–control | Confirmed influenza A (H1N1) cases and critical illnesses and inpatient | 128 | 28.5 | 51/39.8 | Not comparable between two groups (more survival patients used oseltamivir) | Not mentioned |
Zhang, 2013 [43] | China | Case–control | Confirmed influenza A (H1N1) cases and severe or critical ill and ≥14 years old | 2,151 | 34.0 | 1069/49.7 | 95.3% of patients received oseltamivir treatment | No mentioned |
Zhang, 2011 [44] | China | Cohort | Confirmed influenza A (H1N1) cases and critical illnesses and inpatient | 146 | 44.21 | 57/39.0 | Not mentioned | High dose, high dose plus low dose, and low lose |
Viasus, 2011 [45] | Spain | Cohort | Confirmed influenza A (H1N1) cases and pneumonia and inpatient | 197 | N/A | 106/53.8 | No statistical difference exists between steroid group and nonsteroid group | Seventeen (48%) patients received Corticosteroids at a daily dose above 300 mg hydrocortisone or its equivalent |
Patel, 2013 [46] | India | Cohort | Confirmed influenza A (H1N1) cases and ICU | 63 | 34 | 22/35.0 | Patients without pneumonia were treated with oseltamivir, 75 mg p.o. twice daily, and those with pneumonia were treated with 150 mg p.o. twice daily. In pediatric patients, an appropriate weight-based dose of oseltamivir was used | Methylprednisolone 40 mg i.v. every 8 hours for first week followed by every 12 hours for second week and every 24 hours for third week were used for hypoxic patients with pulmonary opacities |
Martin-Loeches, 2011 [47] | Europe | Cohort | Confirmed influenza A (H1N1) and ICU | 220 | 43 | 113/51.4 | All patients received antiviral therapy | Systemic corticosteroid use was considered when dosages equivalent to >24 mg/day methylprednisone or > 30 mg/day prednisone were given at ICU admission |
Mady, 2012 [48] | Saudi Arabia | Cohort | Confirmed influenza A (H1N1) cases and admitted to the ICU and respiratory failure | 86 | 40.8 | 22/28.0 | Not comparable between two groups (more dead patients use antiviral after 48 hours after hospital admission) | Methylprednisolone 1 mg/kg per day for early phase ARDS, continued for 7 days |
Diaz, 2012 [49] | Spain | Cohort | Confirmed influenza A (H1N1) cases and acute respiratory failure requiring ICU admission and pneumonia | 372 | 43.4 | 167/44.9 | All patients received antiviral therapy | Corticosteroids administered were not standardized and were decided by the attending physician |
Chen, 2010 [50] | China | Cohort | Confirmed influenza A (H1N1) cases and critical illnesses | 12 | 33.5 | 6/50.0 | All patients received oseltamivir | Methylprednisolone 80 mg/day (five cases) or 320 mg/day (one case), median duration of corticosteroid treatment was 4.1 ± 1.5 days |
Brun-Buisson, 2011 [51] | France | Cohort | Confirmed influenza A (H1N1) cases and requiring ICU admission and ARDS | 208 | 45.5 | 105/50.5 | Four patients did not receive antiviral therapy. Time from ARI to antiviral therapy use has no significant difference between two groups | Steroid therapy was initiated at a median daily dose equivalent to 270 (IQR, 200 to 400) mg hydrocortisone, and patients were treated for a median duration of 11 (IQR, 6 to 20) days |
Linko, 2011 [52] | Finland | Cohort | Confirmed influenza A (H1N1) cases and admitted to the ICU | 132 | 47 · 8 | 47/35.6 | Oseltamivir was given to 96% patients. No statistical difference between two groups | Not mentioned |
Kudo, 2012 [53] | Japan | Cohort | Confirmed influenza A (H1N1) cases and respiratory disorders and inpatient | 89 | 80 cases < 15 years | 44/49.4 | All subjects were treated with antiviral agents, either oseltamivir or zanamivir | The dosage of corticosteroids was equivalent to methylprednisolone 1.0 to 1.5 mg/body weight (kg)/time, two to four times/day, in subjects under 15 years of age, and 40 to 80 mg/time, two to four times/day in those over 15 years of age. The median number of days from symptom onset to initiation of administration of systemic corticosteroids was 2.1 (range, 1 to 6). The median duration of systemic corticosteroid treatment was 5.2 days (range, 2 to 9) |
Qualitative assessment
Primary outcome – mortality
Case–control studies
Cohort studies
Other clinical outcomes
Publication bias
Discussion
Conclusions
Key messages
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Our findings suggest that corticosteroids have no beneficial effects in treating patients with influenza A (H1N1).
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Available evidence did not support the use of corticosteroids as standard care for patients with severe influenza.
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Our paper will be of interest to medical researchers and physicians who fight against influenza A (H1N1) in the first line.