{
  "abstract": "Introduction Steroids may have a diuretic effect. It is unknown whether they are a useful treatment for venous congestion due to heart failure (HF).Methods A rapid systematic review was conducted following PRISMA guidelines (PROSPERO CRD420200620029). Medline and CENTRAL databases were searched for studies involving adult HF patients receiving steroid. Randomized and observational studies were included. For those data on which meta-analysis (MA) was possible, a random effects model was used to calculate Cohen’s D and unstandardised mean difference (UMD) for continuous variables, and odds and log odds ratios (OR) for categorical variables. Risk of bias was evaluated using ROB-2 and ROBINS-I tools.Results From an initial 4349 records, 17 observational studies, and 6 randomised controlled trials (RCT) involving 22,815 patients were included ( table 1). Oral steroid was associated with greater weight loss (Cohen’s D 0.69 (0.11 – 1.27); P=0.02), although the absolute differences were small (UMD 0.94 kg (standard error = 0.51; P=0.06) (figure 1). Urine volume and natriuresis also tended to be greater with steroid treatment but no MA was possible. Treatment with steroid had no effect on renal function or electrolyte concentrations. Hyperglycaemia was the most common side effect (4-35%) with an OR of 11.19 ((3.22 – 38.90); P<0.01) (figure 2). Steroid treatment was associated with a lower risk of adverse clinical outcomes in RCTs (P<0.05), but no MA was possible. In the four observational studies in which it was reported, steroid treatment was not associated adverse outcome on MA (OR for all-cause mortality 1.01 (0.70 – 1.47; P=0.96).Conclusions Treatment with oral steroid may have a modest diuretic effect when given with loop and/or thiazide diuretics in people with HF. Hyperglycaemia is a common side effect. The data are limited by small sample sizes and heterogeneity of outcomes. More work is needed.Abstract 211 Table 1Randomised study characteristicsStudy(year)Study design(N)HF Population(% or mean/median values)Form and dose of Steroid (and duration)Compared to (and duration)Liu (2006)Randomised, double blind, pilot.(N=20)Out-patients with no congestion. Cr 93 µmol/L. Age 51 years. 60% women. NYHA not reported. LVEF 34%.70% taking furosemide 26 mg/d; 100% taking spironolactone 51 mg/d; 90% taking HCT 33 mg/d; 100% ACEI; 100% BB; 50% digoxinPO prednisolone; 1mg/kg/d (max 60 mg/d)(7 days) Placebo(7 days)Liu (2013)Randomised, open label.(N=34)Out-patients; HeFREF; NYHA III or IV; ‘stable symptoms’; serum urate >9.5 mg/dL. Age 52 years. 12% women. 82% NYHA class IV. LVEF 29%NT-proBNP 8832 ng/L; Cr 109 µmol/L; 35% IHD100% furosemide 62 mg/d; 41% HCT (dose NR). 71% ACE/ARB; 100% BB; 100% MRA; 100% digitalisPO prednisolone; 1mg/kg/d (max 60 mg/d)(28 days)Allopurinol 100 mg/day(28 days)Liu (2014)Randomised, open label (N=102)In-patients. Cr 104 µmol/L; 50% IHD; Age 58 years. 37% women. 100% NYHA IV. LVEF 33%. 92 % loop diuretic (dose and type NR); 57% ACEI or ARB; 55%BB; 61% MRA; 73% digoxin; 69% IV vasodilator; 57% inotropic supportDexamethasone 20 mg IV followed by PO prednisolone; 1mg/kg/d (max 60 mg/d) for 7 days and weaned in 3 days.(10 days)Usual care(10 days)Raymond (2014)Randomised, open label (N=40)In-patients; ‘refractory decompensation’.No characteristics or concurrent medications reportedPO prednisolone; 1mg/kg/d (max 60 mg/d)(9 days)usual care(9 days)Liu (2015)Randomised, open label, dose comparison trial(N=40)In-patients. NT-proBNP 2200 ng/L; Cr 79 µmol/L. Age 55. 50% women. 70% NYHA class IV. LVEF 34%. 100% furosemide 41 mg/d; 70% HCT 18.7 mg/d; 70% ACEI; 100% BB; 100% MRAPO Prednisolone low dose - 15mg/d; moderate dose 30 mg/d; high dose 60 mg/d for 7 days and weaned in 3 days(10 days)Usual care(10 days)Cotter (2024)Randomised, open-label, (N=100)In-patients. NT-proBNP 4528 ng/L; Cr 103 µmol/L; 42% DM; 90% IHD. Age 67. 39% women. 86% NYHA class III-IV. LVEF 28%.100% furosemide 105.4mg/d; 12% thiazide (dose and type NR); 71% RAASI; 58% BB; 0% MRA; 12% SGLT2I; 10% digoxinPO Prednisolone 40mg/d(7 days)Usual care(7 days)Abbreviations used: HF – Heart failure; NYHA – New York Heart Association; RCT – randomised controlled trial; LVEF – left ventricular ejection fraction; ACEI – angiotensin converting enzyme inhibitor; NT-proBNP – N-terminal pro-B-type natriuretic peptide; DM – diabetes mellitus; IHD – ischaemic heart disease; AF – atrial fibrillation; RRT – renal replacement therapy; HFH – heart failure hospitalisation; eGFR – estimated glomerular filtration rate; SBP – systolic blood pressure; IM – intra-muscular; LD – loop diuretic; ARB – angiotensin receptor blocker; βB – beta-blocker; MRA – mineralocorticoid receptor antagonist; ARNI – angiotensin receptor neprilysin inhibitor; SGLT2I – sodium glucose co-transporter 2 inhibitor; g – gram; d – day;Abstract 211 Figure 1Abstract 211 Figure 2",
  "authors": [
    {
      "affiliations": [
        "Hull York Medical School, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Madison Gill"
    },
    {
      "affiliations": [
        "Hull York Medical School, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Dionisius Ardiyanto"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Hammad Buksh Ilahi"
    },
    {
      "affiliations": [
        "Hull York Medical School, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Alicia Pearson"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Ibrahim Mahmoud"
    },
    {
      "affiliations": [
        "Hull York Medical School, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Sarah Greenley"
    },
    {
      "affiliations": [
        "Hull York Medical School, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Andrea Hilton"
    },
    {
      "affiliations": [
        "University of Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Lee Middleton"
    },
    {
      "affiliations": [
        "University of Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Jon Bishop"
    },
    {
      "affiliations": [
        "Hull York Medical School, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Miriam J Johnson"
    },
    {
      "affiliations": [
        "Glasgow University, Glasgow, United Kingdom"
      ],
      "name": "John GF Cleland"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Andrew Clark"
    },
    {
      "affiliations": [
        "Hull York Medical School, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Maureen Twiddy"
    },
    {
      "affiliations": [
        "Hull York Medical School, Kingston-Upon-Hull, United Kingdom",
        "Hull University Teaching Hospitals NHS Trust, Kingston-Upon-Hull, United Kingdom"
      ],
      "name": "Joseph J Cuthbert"
    }
  ],
  "title": "211 The diuretic effect of steroids in pateints with heart failure: a rapid review, narrative synthesis and meta-analysis",
  "uid": "79315086-56b7-508e-8f2c-76f574062f83"
}