The Effects Of Corticosteroid Adjuvant Therapy On The Patients With Viral Pneumonia:a Meta-analysis

Background and objective:In recent years,with the increased incidence of viral pneumonia,the treatment of viral pneumonia is becoming more and more attention,in addition to the routine therapy,such as antiviral treat ? the basic support treatment,corticosteroid usually was used as an adjuvant therapy of viral pneumonia because it can inhibit inflammation.But with the progress of the research,corticosteroid may increase the nosocomial infection,prolonging the time of vrial shedding,also may be associated with mortality.At present,there is no evidence to indicate that corticosteroid is always beneficial for viral pneumonia.Therefore,we want to conduct a Meta-analysis by searching and collecting relevant literatures of clinical trial to study the effects of corticosteroid on patients with viral pneumonia.Methods: By extracting keywords and building retrieval expressions,and then searching related literatures which are before February 2019 respectively in English and Chinese database,such as Pubmed,the Cochrane Library,CBM,CNKI.According to the inclusion criteria and exclusion criteria,finally screening out 8 literatures which are meeting the requirement,a total of 4947 patients with viral pneumonia are included,the main outcome of these studies is mortality rate?nosocomial infection?length of staying in hospital(ICU)? duration of mechanical ventilation,and using random or fixed effect model of Review Manager software to finalize the synthesis and analysis of the data,using Newcastle-Ottawa model to evaluate the quality of the literatures including in the research.Results: The 8 literatures intaking all are in English and retrospective studies.The results of the Meta-analysis showed that corticosteroid was significantly correlated with the mortality of patients with viral pneumonia(OR=2.31,95%CI 1.31-4.07,P=0.004),especially the mortality in ICU(OR=1.60,95%CI 1.31-1.95,P<0.00001),but there was no significant difference with hospitalizated time(including hospitalizated time in ICU)and mechanical ventilation time.These results suggest that corticosteroid can increase the mortality of patients with viral pneumonia,but have no effect on nosocomial infection,length of stay(including ICU stay)and duration of mechanical ventilation.Conclusion: Corticosteroid cannot be used as a conventional adjuvant therapy for patients with viral pneumonia,it should be individual treatment.But all the literatures included in this research are retrospective studies,which have certain bias.Hoping that the conclusion in the study can be verified in randomized controlled trials in the future.