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 300Â 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, 75Â mg p.o. twice daily, and those with pneumonia were treated with 150Â mg p.o. twice daily. In pediatric patients, an appropriate weight-based dose of oseltamivir was used | Methylprednisolone 40Â mg i.v. every 8Â hours for first week followed by every 12Â hours for second week and every 24Â 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 48Â hours after hospital admission) | Methylprednisolone 1Â mg/kg per day for early phase ARDS, continued for 7Â 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) |