Corticosteroids Associated With Increased Mortality in Influenza Pneumonia

The use of corticosteroids in people with influenza pneumonia is associated with higher rates of mortality, according to a commentary recently published in the Annals of Emergency Medicine.¹ 

A systematic review² included 6548 individuals from 10 separate trials, which were sourced from Embase, Medline, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials databases. Controls were included in all studies and participants were administered either corticosteroids or placebo for influenza pneumonia. Mortality was the primary outcome of the study, while intensive care unit (ICU) length of stay, mechanical ventilation, and secondary infection rate were the secondary outcomes. The Newcastle-Ottawa Scale was used to examine the quality of the studies and assessments were conducted by 2 investigators, to decrease the risk of bias.

All outcome measures except ICU length of stay showed significant heterogeneity in the 10 selected studies (ICU length of stay, I²=38%; P =.21; mechanical ventilation days, I²=53%; P =.12; mortality, I²=84%; P <.00001; secondary infection rate, I²=94%; P <.00001). However, there was a significant association between corticosteroid use and mortality, with a risk ratio (RR) of 1.75 (95% CI, 1.30-2.36; Z=3.71; P =.0002) compared with placebo. Similarly, corticosteroids correlated with higher rate of secondary infection (RR 1.98; 95% CI, 1.04-3.78; Z=2.08; P =.04) and longer ICU length of stay (mean difference 2.14; 95% CI, 1.17-3.10; Z=4.35; P <.0001) compared with placebo. The number of days on mechanical ventilation did not differ significantly between the corticosteroid and placebo groups (mean difference 0.81; 95% CI, -1.28 to2.84; P =.44).^1,2

Limitations to this study included a lack of randomized controlled trials, a lack of data on corticosteroid dose and duration of use, the potential influence of varying baseline characteristics on outcomes, and the present controversy over the use of corticosteroids in patients with influenza pneumonia.^1,2

“Corticosteroids could increase mortality in patients with influenza pneumonia. Randomized controlled studies are needed to further verify this conclusion,” the researchers concluded.²

References

1. Gottlieb M, Seagraves T, Gore SR. Do corticosteroids benefit patients with influenza pneumonia? [published online July 23, 2019]. Ann Emerg Med. doi:10.1016/j.annemergmed.2019.06.021
2. Ni Y-N, Chen G, Sun J, Liang B-M, Liang Z-A. The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis. Crit Care. 2019;23:99.

This article originally appeared on Pulmonology Advisor