Lin Ding1, Huixue Huang2, Heyan Wang3, Hangyong He4,5,6. 1. Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Beijing, China. 2. Department of Medicine, Beijing University of Technology Hospital, Beijing, China. 3. Department of Critical Care Medicine, The Sixth Hospital of Guiyang, Guiyang, Guizhou, China. 4. Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China. yonghang2004@sina.com. 5. Beijing Engineering Research Center for Diagnosis and Treatment of Pulmonary and Critical Care, Beijing, China. yonghang2004@sina.com. 6. Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China. yonghang2004@sina.com.
Abstract
BACKGROUND: Evidence supporting corticosteroids adjunctive treatment (CAT) for Pneumocystis jirovecii pneumonia (PCP) in non-HIV patients is highly controversial. We aimed to systematically review the literature and perform a meta-analysis of available data relating to the effect of CAT on mortality of PCP in non-HIV patients. METHODS: We searched Pubmed, Medline, Embase, and Cochrane database from 1989 through 2019. Data on clinical outcomes from non-HIV PCP were extracted with a standardized instrument. Heterogeneity was assessed with the I2 index. Pooled odds ratios and 95% confidence interval were calculated using a fixed effects model. We analyzed the impact of CAT on mortality of non-HIV PCP in the whole PCP population, those who had hypoxemia (PaO2 < 70 mmHg) and who had respiratory failure (PaO2 < 60 mmHg). RESULTS: In total, 259 articles were identified, and 2518 cases from 16 retrospective observational studies were included. In all non-HIV PCP cases included, there was an association between CAT and increased mortality (odds ratio, 1.37; 95% confidence interval 1.07-1.75; P = 0.01). CAT showed a probable benefit of decreasing mortality in hypoxemic non-HIV PCP patients (odds ratio, 0.69; 95% confidence interval 0.47-1.01; P = 0.05). Furthermore, in a subgroup analysis, CAT showed a significantly lower mortality in non-HIV PCP patients with respiratory failure compared to no CAT (odds ratio, 0.63; 95% confidence interval 0.41-0.95; P = 0.03). CONCLUSIONS: Our meta-analysis suggests that among non-HIV PCP patients with respiratory failure, CAT use may be associated with better clinical outcomes, and it may be associated with increased mortality in unselected non-HIV PCP population. Clinical trials are needed to compare CAT vs no-CAT in non-HIV PCP patients with respiratory failure. Furthermore, CAT use should be withheld in non-HIV PCP patients without hypoxemia.
BACKGROUND: Evidence supporting corticosteroids adjunctive treatment (CAT) for Pneumocystis jirovecii pneumonia (PCP) in non-HIVpatients is highly controversial. We aimed to systematically review the literature and perform a meta-analysis of available data relating to the effect of CAT on mortality of PCP in non-HIVpatients. METHODS: We searched Pubmed, Medline, Embase, and Cochrane database from 1989 through 2019. Data on clinical outcomes from non-HIVPCP were extracted with a standardized instrument. Heterogeneity was assessed with the I2 index. Pooled odds ratios and 95% confidence interval were calculated using a fixed effects model. We analyzed the impact of CAT on mortality of non-HIVPCP in the whole PCP population, those who had hypoxemia (PaO2 < 70 mmHg) and who had respiratory failure (PaO2 < 60 mmHg). RESULTS: In total, 259 articles were identified, and 2518 cases from 16 retrospective observational studies were included. In all non-HIVPCP cases included, there was an association between CAT and increased mortality (odds ratio, 1.37; 95% confidence interval 1.07-1.75; P = 0.01). CAT showed a probable benefit of decreasing mortality in hypoxemic non-HIVPCPpatients (odds ratio, 0.69; 95% confidence interval 0.47-1.01; P = 0.05). Furthermore, in a subgroup analysis, CAT showed a significantly lower mortality in non-HIVPCPpatients with respiratory failure compared to no CAT (odds ratio, 0.63; 95% confidence interval 0.41-0.95; P = 0.03). CONCLUSIONS: Our meta-analysis suggests that among non-HIVPCPpatients with respiratory failure, CAT use may be associated with better clinical outcomes, and it may be associated with increased mortality in unselected non-HIVPCP population. Clinical trials are needed to compare CAT vs no-CAT in non-HIVPCPpatients with respiratory failure. Furthermore, CAT use should be withheld in non-HIVPCPpatients without hypoxemia.
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