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Table 1 Baseline characteristics of included studies

From: Do corticosteroids reduce the mortality of influenza A (H1N1) infection? A meta-analysis

First author, year Country Study design Population Sample size Mean/median age (years) Female ( n /%) Antiviral Corticosteroid doses and duration
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)
  1. ARDS, acute respiratory distress syndrome; ARI, acute respiratory infection; IQR, interquartile range; i.v., intravenously; p.o., per os.