Glucocorticoids for acute respiratory distress syndrome: A systematic review with meta‐analysis and trial sequential analysis

Background Glucocorticoids are some of the most commonly used drugs for patients with acute respiratory distress syndrome (ARDS). However, the curative effect and side effects of glucocorticoids in treating patients with ARDS remain controversial. Methods Three databases were searched until 2 July 2020, and randomized controlled trials (RCTs) that compared glucocorticoids versus other therapies in the treatment of ARDS were included in this meta‐analysis. Trial sequential analysis (TSA) was conducted. Results A total of 14 RCTs with 1362 ARDS patients were assessed. Overall, no statistically significant effect was found on mortality between the glucocorticoid group and the control group of ARDS patients. In the subgroup analysis, no benefit of glucocorticoids for ARDS on mortality was found in trials stratified according to low versus high risk of bias or with vs. without a loading dose. As for the dose and length of therapy, no statistically significant effect was found on mortality with high‐dose, short‐course glucocorticoid therapy. However, lower‐dose and longer‐course therapy with glucocorticoids was found to decrease the mortality of ARDS patients (lower dose: RR = 0.69, 95% CI = 0.51‐0.93, P = .02; longer‐course therapy: RR = 0.60, 95% CI = 0.37‐0.99, P = .04). The TSA showed that more trials are needed to confirm the results. Conclusions Longer‐ and lower‐dose glucocorticoid treatment may improve the prognosis of ARDS patients, but RCTs with higher quality and larger sample sizes are needed to further clarify the clinical effects of glucocorticoids on ARDS.