Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Rodrigo, Chamira; Leonardi-Bee, Jo; Nguyen-Van-Tam, Jonathan; Lim, Wei Shen (2016)
Publisher: Wiley
Languages: English
Types: Article
Background: Specific treatments for influenza are limited to neuraminidase inhibitors and adamantanes. Corticosteroids show evidence of benefit in sepsis and related conditions, most likely due to their anti-inflammatory and immunomodulatory properties. Although commonly prescribed for severe influenza, there is uncertainty over their potential benefit or harm. \ud \ud Objectives: To systematically assess the effectiveness and potential adverse effects of corticosteroids as adjunctive therapy in the treatment of influenza, taking into account differences in timing and doses of corticosteroids. \ud \ud Search methods: We searched CENTRAL (2015, Issue 5), MEDLINE (1946 to June week 1, 2015), EMBASE (1974 to June 2015), CINAHL (1981 to June 2015), LILACS (1982 to June 2015), Web of Science (1985 to June 2015), abstracts from the last three years of major infectious disease and microbiology conferences, and references of included articles. \ud \ud Selection criteria: We included randomised controlled trials (RCTs), quasi-RCTs and observational studies that compared corticosteroid treatment with no corticosteroid treatment for influenza or influenza-like illness. We did not restrict studies by language of publication, influenza subtypes, clinical setting or age of participants. We selected eligible studies in two stages: sequential examination of title and abstract, followed by full text. \ud \ud Data collection and analysis: Two pairs of review authors independently extracted data and assessed risk of bias. We pooled estimates of effect using random-effects meta-analysis models, where appropriate. We assessed heterogeneity using the I2 statistic and assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. \ud \ud Main results: We identified 19 eligible studies (3459 individuals), all observational; 13 studies (1917 individuals) were suitable for inclusion in the meta-analysis of mortality. Of these, 12 studied patients infected with 2009 influenza A H1N1 virus (H1N1pdm09). Risk of bias was greatest in the 'comparability domain' of the Newcastle-Ottawa scale, consistent with potential confounding by indication. Data specific to mortality were of very low quality. Reported doses of corticosteroids used were high and indications for their use were not well reported. On meta-analysis, corticosteroid therapy was associated with increased mortality (odds ratio (OR) 3.06, 95% confidence interval (CI) 1.58 to 5.92). Pooled subgroup analysis of adjusted estimates of mortality from four studies found a similar association (OR 2.82, 95% CI 1.61 to 4.92). Three studies reported greater odds of hospital-acquired infection related to corticosteroid therapy; all were unadjusted estimates and we graded the data as very low quality. \ud \ud Authors' conclusions: We did not identify any completed RCTs of adjunctive corticosteroid therapy for treating influenza. The available evidence from observational studies is of very low quality with confounding by indication a major potential concern. Although we found that adjunctive corticosteroid therapy was associated with increased mortality, this result should be interpreted with caution. In the context of clinical trials of adjunctive corticosteroid therapy in sepsis and pneumonia that report improved outcomes, including decreased mortality, more high-quality research is needed (both RCTs and observational studies). Currently, we do not have sufficient evidence in this review to determine the effectiveness of corticosteroids for patients with influenza.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • tn % o 5 o 9 f s in it d
    • u he ts t Balaganesakumar 2013 {published data only} Balaganesakumar SR, Murhekar MV, Swamy KK, Kumar MR, Manickam P, Pandian P. Risk factors associated with death among influenza A (H1N1) patients, Tamil Nadu, India, 2010. Journal of Postgraduate Medicine 2013;59: 9-14.
    • Boudreault 2011 {published data only} ∗ Boudreault A, Xie H, Leisenring W, Englund J, Corey L, Boeckh M. Impact of corticosteroid treatment and antiviral therapy on clinical outcomes in hematopoietic cell transplant patients infected with influenza virus. Biology of Blood and Marrow Transplantation 2011;17(7):979-86.
    • Brun-Buisson 2011 {published data only} ∗ Brun-Buisson C, Jean-Christophe M, Mercat A, Thiebaut A, Brochard L. Early corticosteroids in severe influenza A/ H1N1 pneumonia and acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine 2011;183(9):1200-6.
    • Chawla 2013 {published data only} Chawla R, Kansal S, Chauhan M, Jain A, Jibhkate B. Predictors of mortality and length of stay in hospitalized cases of 2009 influenza A (H1N1): experiences of a tertiary care center. Indian Journal of Critical Care Medicine 2013; 17:275-82.
    • Delgado-Rodriguez 2012 {published data only} Delgado-Rodriguez M, Castilla J, Godoy P, Martin V, Soldevila N, Alonso J, et al. Prognosis of hospitalized patients with 2009 H1N1 influenza in Spain: influence of neuraminidase inhibitors. Journal of Antimicrobial Chemotherapy 2012;67(7):1739-45.
    • Diaz 2012 {published data only} Diaz E, Martin-Loeches I, Canadell L, Vidaur L, Suarez D, Socias L, et al. Corticosteroid therapy in patients with primary viral pneumonia due to pandemic (H1N1) 2009 influenza. Journal of Infection 2012;64(3):311-8.
    • Han 2011 {published data only} Han K, Ma H, An X, Su Y, Chen J, Lian Z, et al. Early use of glucocorticoids was a risk factor for critical disease and death from pH1N1 infection. Clinical Infectious Diseases 2011;53(4):326-33.
    • Jain 2009 {published data only} Jain S, Kamimoto L, Bramley A, Schmitz A, Benoit S, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. New England Journal of Medicine 2009;361(20):1935-44.
    • Kim 2011 {published data only} Kim S, Hong S, Yun S, Choi W, Ahn J, Lee Y, et al. Corticosteroid treatment in critically ill patients with pandemic influenza A/H1N1 2009 infection: analytic strategy using propensity scores. American Journal of Respiratory and Critical Care Medicine 2011;183(9): 1207-14.
    • Kudo 2012 {published data only} Kudo K, Takasaki J, Manabe T, Uryu H, Yamada R, Kuroda E, et al. Systemic corticosteroids and early administration of antiviral agents for pneumonia with acute wheezing due to influenza A (H1N1) pdm09 in Japan. PloS One 2012;7 (2):e32280.
    • Li 2012 {published data only} Li F, Chen G, Wang J, Liu H, Wu J. A case-control study on risk factors associated with death in pregnant women with severe pandemic H1N1 infection. BMJ Open 2012;2: e000827.
    • Liem 2009 {published data only} Liem N, Tung C, Hien N, Hien T, Chau N, Long H, et al. Clinical features of human influenza A (H5N1) infection in Vietnam: 2004-2006. Clinical Infectious Diseases 2009;48 (12):1639-46.
    • Linko 2011 {published data only} Linko R, Pettila V, Ruokonen E, Varpula T, Karlsson S, Tenhunen J, et al. Corticosteroid therapy in intensive care unit patients with PCR-confirmed influenza A (H1N1) infection in Finland. Acta Anaesthesiologica Scandinavica 2011;55(8):971-9.
    • Mady 2012 {published data only} Mady A, Ramadan O, Yousef A, Mandourah Y, Amr A, Kherallah M. Clinical experience with severe 2009 H1N1 influenza in the intensive care unit at King Saud Medical City, Saudi Arabia. Journal of Infection and Public Health 2012;5(1):52-6.
    • Patel 2013 {published data only} Patel K, Patel A, Mehta P, Amin R, Patel K, Chuhan P, et al. Clinical outcome of novel H1N1 (swine flu)-infected patients during 2009 pandemic at tertiary referral hospital in western India. Journal of Global Infectious Diseases 2013; 5:93-7.
    • Sertogullarindan 2011 {published data only} Sertogullarindan B, Ozbay B, Gunini H, Sunnetcioglu A, Arisoy A, Bilgin HM, et al. Clinical and prognostic features of patients with pandemic 2009 influenza a (H1N1) virus in the intensive care unit. African Health Sciences 2011;11 (2):163-70.
    • Viasus 2011 {published data only} Viasus D, Pano-Pardo J, Cordero E, Campins A, LopezMedrano F, Villoslada A, et al. Effect of immunomodulatory therapies in patients with pandemic influenza A (H1N1) 2009 complicated by pneumonia. Journal of Infection 2011; 62(3):193-9.
    • Wu 2012 {published data only} Wu U, Wang J, Ho Y, Pan S, Chen Y, Chang S. Factors associated with development of complications among adults with influenza: a 3-year prospective analysis. Journal of the Formosan Medical Association 2012;111(7):364-9.
    • Xi 2010 {published data only} Xi X, Xu Y, Jiang L, Li A, Duan J, Du B, et al. Hospitalized adult patients with 2009 influenza A (H1N1) in Beijing, A N A L Y S E S (40 to 56) (24 to 36); (SD) of COPD: no P value = 0. highCS 5%; CS 001 est methyl8% pred dose 94 Other (± 43) mg obstructive and hydropulmonary cortidisease: sone 214 (± no CS 23%; 66) mg CS 21% Timing: median (IQR) days after symptom onset 5.0 (2.
    • 8 to 8.3)
  • No related research data.
  • No similar publications.

Share - Bookmark

Cite this article