THE ROLE OF TREATMENT WITH HIGH-DOSE CORTICOSTEROIDS IN SEVERE LEPTOSPIROSIS WITH PULMONARY COMPLICATIONS
DOI:
https://doi.org/10.22159/ijap.2019.v11s6.33546Keywords:
Severe leptospirosis, Acute Respiratory Distress Syndrome, High-dose corticosteroidsAbstract
Objective: To investigate the effectiveness of high-dose corticosteroids in patients with severe leptospirosis, especially in reducing morbidity and mortality rates.
Methods: Literature searches were conducted using PubMed® and SCOPUS®. One systematic review and one systematic review with meta-analysis were selected from three chosen studies.
Results: The systematic review from Rodrigo et al. only included qualitative synthesis from four interventional studies. Early administration of methylprednisolone can be beneficial; however, low number and poor methodological quality of the studies question the validity of this review. Duggal et al. stated that there was no significant difference in the therapeutic effects of early high-dose corticosteroids (P ³ 0.05; 95% CI: 0.81–1.37), early low-dose corticosteroids (P ³ 0.05; 95% CI: 0.3–1.03), and late low-dose corticosteroids (P ³ 0.05; 95% CI: 0.11–2.52). Limited number of studies and high statistical heterogeneity, however, are major drawbacks for this review.
Conclusion: Evidence about the role of high-dose corticosteroids in severe leptospirosis patients with pulmonary complications, especially their benefits, is still limited. Additional randomized, controlled trials with adequate statistical power still need to be conducted.
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References
2. Gonçalves-de-Albuquerque CF, Burth P, Silva AR, Younes Ibrahim M, Castro-Faria Neto HC, Castro Faria MV. Review article: Leptospira and inflammation. Mediators Inflamm 2012;1-11. http://dx.doi.org/10.1155/2012/317950
3. Gulati S, Gulati A. Pulmonary manifestation of leptospirosis. Lung India 2012;29:347-53.
4. Rodrigo C, de Silva NL, Goonaratne R, Samarasekara K, Wijesinghe I, Parththipan B, et al. High-dose corticosteroids in severe leptospirosis: a systematic review. Trans R Soc Trop Med Hyg 2014;108:743-50.
5. Duggal A, Ganapathy A, Ratnapalan M, Adhikari NKJ. Pharmacological treatments for acute respiratory distress syndrome: Systematic review. Minerva Anestesiol 2015;81:567-88.
6. Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Pulmonary perspectives. Am Rev Respir Dis 1988;138:720-3.
7. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24.
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