Sign In    Register

World Journal of Emergency Medicine ›› 2021, Vol. 12 ›› Issue (3): 207-213.doi: 10.5847/wjem.j.1920-8642.2021.03.008

• Original Articles • Previous Articles     Next Articles

Efficacy and safety of low-dose corticosteroids for acute respiratory distress syndrome: A systematic review and meta-analysis

Yu-qing Cui1, Xian-fei Ding1, Huo-yan Liang1, Dong Wang1, Xiao-juan Zhang1, Li-feng Li2, Quan-cheng Kan3, Le-xin Wang4, Tong-wen Sun1()   

  1. 1 General ICU, the First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou Key Laboratory of Sepsis, Henan Engineering Research Center for Critical Care Medicine, Zhengzhou 450052, China
    2 Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
    3 Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
    4 School of Biomedical Sciences, Charles Sturt University, Wagga Wagga 2650, Australia
  • Received:2020-05-29 Accepted:2021-01-21 Online:2021-06-01 Published:2021-05-31
  • Contact: Tong-wen Sun


BACKGROUND: There are conflicting results regarding whether corticosteroids have better efficacy than placebo in acute respiratory distress syndrome (ARDS) patients. Therefore, we aim to further evaluate the efficacy and safety of corticosteroids in adult ARDS patients.

METHODS: The databases, including Medline, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, were searched from their inception to May 2, 2020. Randomized controlled trials (RCTs) and observational cohort studies were selected to assess the use of corticosteroids in adult ARDS patients. The quality of the results was judged by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The inverse-variance method with random or fixed effects modeling was used to compute pooled odds ratio (OR), standardized mean difference (SMD), and their 95% confidence interval (CI).

RESULTS: Eight eligible RCTs and six cohort studies were included. The use of corticosteroids was associated with reduced mortality (OR 0.57, 95% CI 0.43-0.76, I2=35.1%, P=0.148) in ARDS patients, and the result was confirmed in the included cohort studies (OR 0.51, 95% CI 0.27-0.95, I2=66.7%, P=0.010). The subgroup analysis stratified by the initiation time and duration of corticosteroid use showed that early ARDS and prolonged corticosteroid use had significant survival benefits in the RCTs. The low-dose corticosteroid use was also associated with significantly more ventilator-free days and a reduced rate of new infections in ARDS patients.

CONCLUSIONS: The low-dose corticosteroid therapy may be safe and reduce mortality, especially in patients with prolonged treatment and early ARDS.

Key words: Low-dose, Corticosteroid, Acute respiratory distress syndrome, Mortality, Systematic review, Meta-analysis