Corticosteroids Affect Mortality Risk Among Patients With Influenza

Individuals with influenza who receive corticosteroids may be at an increased risk for mortality and hospital-acquired infections, according to a new study.

To conduct their study, the researchers identified 29 observational studies and 1 randomized controlled trial (RCT) that had compared the effects of corticosteroid use with no corticosteroid treatment among individuals with influenza. The research was found in trial registries and from 6 electronic databases and had been published in October 2018 or earlier.

Overall, 21 observational studies were included in the meta-analysis of mortality; the meta-analysis suggested an adverse association between mortality and corticosteroid therapy.

A risk of bias assessment was performed, and the assessment was consistent with potential confounding by indication. 

By evaluating a pooled analysis of 7 studies, the researchers determined that patients with influenza who had been treated with corticosteroids had an increased risk of hospital-acquired infections (unadjusted odds ratio, 2.74; 95% CI, 1.51–4.95).

According to a meta-regression of the effect of corticosteroid dose on mortality, there was no association. However, the studies had included high doses of corticosteroids (mostly methylprednisolone [or equivalent], 40 mg, or more per day).

“Corticosteroid treatment in influenza is associated with increased mortality and hospital-acquired infection, but the evidence relates mainly to high corticosteroid doses and is of low quality with potential confounding by indication a major concern,” the researchers concluded.

—Colleen Murphy

Reference:

Lansbury LE, Rodrigo C, Leonardi-Bee Jo, Nguyen-Van-Tam J, Shen Lim W. Corticosteroids as adjunctive therapy in the treatment of influenza: an updated Cochrane systematic review and meta-analysis. Crit Care Med. 2020;48(2):e98-e106. doi:10.1097/CCM.0000000000004093.