The Impact of Corticosteroids on the Outcome of Fungal Disease: a Systematic Review and Meta-analysis.

IF 2.3 Q3 INFECTIOUS DISEASES

Current Fungal Infection Reports Pub Date : 2023-01-01 DOI:10.1007/s12281-023-00456-2

Zhaolun Li, David W Denning

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引用次数: 6

Abstract

Purpose of review: Corticosteroids have a complex relationship with fungal disease - risk for many, benefit for others. This systematic review aims to address the effect of corticosteroids on mortality and visual outcome in different fungal diseases.

Recent findings: Corticosteroids are a risk factor of aspergillosis for patients who have COVID-19, and they also led to a worse outcome. Similarity, corticosteroids are a risk factor for candidemia and mucormycosis. Some researchers reported that using topical corticosteroid in keratitis was associated with worse visual outcome if fungal keratitis. Some studies showed that corticosteroids are linked to a negative outcome for non-HIV patients with Pneumocystis jirovecii pneumonia (PCP), in contrast to those with HIV and PCP.

Summary: In 59 references, we found that corticosteroid therapy showed a worse clinical outcome in invasive aspergillosis (IA) (HR: 2.50, 95%CI: 1.89-3.31, p < 0.001) and chronic pulmonary aspergillosis (CPA) (HR: 2.74, 95%CI: 1.48-5.06, p = 0.001), PCP without HIV infection (OR: 1.29, 95%CI: 1.09-1.53, p = 0.003), invasive candidiasis and candidaemia (OR: 2.13, 95%CI: 1.85-2.46, p < 0.001), mucormycosis (OR: 4.19, 95%CI: 1.74-10.05, p = 0.001) and early in the course of fungal keratitis (OR: 2.99, 95%CI: 1.14-7.84, p = 0.026). There was equivocal outcome in cryptococcal meningoencephalitis in AIDS and primary coccidioidomycosis, while corticosteroid therapy showed a better outcome in PCP in HIV-infected patients (RR: 0.62, 95%CI: 0.46-0.83, p=0.001) and fungal keratitis patients after keratoplasty surgery (OR: 0.01, 95%CI: 0.00-0.41, p = 0.041) and probably in cryptococcal meningoencephalitis in non-immunocompromised patients. A sub-analysis in invasive aspergillosis and CPA showed that use of more than 2 mg/kg/day of prednisolone equivalents per day is a significant factor in increasing mortality (HR: 2.94, 95%CI: 2.13-4.05, p < 0.001). Corticosteroid therapy during invasive fungal disease was usually associated with a slightly or greatly increased mortality or worse visual outcome (in fungal keratitis), with two disease exceptions. Avoiding the addition of corticosteroids, or minimising dose and duration in those who require them, is likely to improve the outcome of most life- and vision-threatening fungal diseases. This review provides a cornerstone for further research in exploring the accuracy of suitable dose and duration of corticosteroids treatment in fungal diseases.

Supplementary information: The online version contains supplementary material available at 10.1007/s12281-023-00456-2.

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皮质类固醇对真菌性疾病结局的影响:一项系统综述和荟萃分析。

综述目的:皮质类固醇与真菌疾病有着复杂的关系——对许多人来说是危险的，对其他人来说是有益的。本系统综述旨在解决糖皮质激素对不同真菌疾病的死亡率和视力结果的影响。最近的发现:皮质类固醇是COVID-19患者患曲霉病的一个危险因素，也会导致更糟糕的结果。同样，皮质类固醇是念珠菌病和毛霉菌病的危险因素。一些研究人员报道，如果真菌性角膜炎，使用局部皮质类固醇治疗角膜炎会导致更差的视力结果。一些研究表明，与艾滋病毒和肺囊虫肺炎(PCP)患者相比，皮质类固醇与非艾滋病毒感染者的阴性结果有关。摘要:在59篇文献中，我们发现皮质类固醇治疗在侵袭性曲霉病(IA) (HR: 2.50, 95%CI: 1.89-3.31, p = 0.001)、未感染HIV的PCP (OR: 1.29, 95%CI: 1.09-1.53, p = 0.003)、侵袭性念珠菌病和念珠菌血症(OR: 2.13, 95%CI: 1.85-2.46, p = 0.001)和真菌性角膜炎病程早期(OR: 2.99, 95%CI: 1.14-7.84, p = 0.026)中表现出较差的临床结果。艾滋病隐球菌性脑膜脑炎和原发性球孢子菌病的预后不明确，而皮质类固醇治疗在hiv感染患者的PCP (RR: 0.62, 95%CI: 0.46-0.83, p=0.001)和角膜移植术后真菌性角膜炎患者(OR: 0.01, 95%CI: 0.00-0.41, p= 0.041)以及非免疫功能受损患者的隐球菌性脑膜脑炎中表现出更好的预后。侵袭性曲霉病和CPA的亚分析显示，每天使用超过2 mg/kg/天的泼尼松龙当量是增加死亡率的重要因素(HR: 2.94, 95%CI: 2.13-4.05, p)。补充信息:在线版本包含补充材料，可在10.1007/s12281-023-00456-2获得。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Fungal Infection Reports INFECTIOUS DISEASES-

CiteScore

3.10

自引率

7.10%

发文量

期刊介绍： This journal intends to provide clear, insightful, balanced contributions that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of fungal infections. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as advances in diagnosis, current and emerging management approaches, and genomics and pathogenesis. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. Commentaries from well-known figures in the field are also provided, and an international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research.