Summary of findings for the main comparison. SCS treatment for 7 or fewer days compared with SCS treatment for longer than 7 days for acute exacerbations of COPD.
| SCS treatment for 7 or fewer days compared with SCS treatment for longer than 7 days for acute exacerbations of COPD | ||||||
| Patient or population: patients with acute exacerbations of COPD Settings: hospital‐initiated treatment Intervention: SCS treatment for 7 or fewer days Comparison: SCS treatment for longer than 7 days | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| SCS treatment for longer than 7 days | SCS treatment for 7 or fewer days | |||||
| Treatment failure Need for additional treatment Follow‐up: 10 to 14 days | 83 per 1000 | 61 per 1000 (32 to 117) | OR 0.72 (0.36 to 1.46) | 457 (4 studies) | ⊕⊕⊕⊝ Moderatea | Equivalent to 22 fewer (95% CI 51 fewer to 34 more) |
| Relapse New acute exacerbation or COPD‐related admission Follow‐up: 14 to 180 days | 295 per 1000 | 304 per 1000 (227 to 395) | OR 1.04 (0.7 to 1.56) | 478 (4 studies) | ⊕⊕⊕⊝ Moderatea | In one study (Leuppi 2013), hazard ratio for time to re‐exacerbation was 0.95 (95% CI 0.66 to 1.37) |
| Adverse drug effect—hyperglycaemia Follow‐up: 3 to 14 days | 442 per 1000 | 439 per 1000 (336 to 548) | OR 0.99 (0.64 to 1.53) | 345 (2 studies) | ⊕⊕⊕⊝ Moderatea | |
| Adverse drug effects Gastrointestinal tract bleeding, symptomatic gastrointestinal reflux, symptoms of congestive heart failure or ischaemic heart disease, sleep disturbance, fractures, depression Follow‐up: 10 to 180 days | 84 per 1000 | 75 per 1000 (40 to 135) | OR 0.88 (0.46 to 1.7) | 503 (5 studies) | ⊕⊕⊝⊝ Lowa,b | |
| Mortality Follow‐up: 14 to 180 days | 77 per 1000 | 71 per 1000 (32 to 147) | OR 0.91 (0.4 to 2.06) | 336 (2 studies) | ⊕⊕⊕⊝ Moderatea | |
| Length of hospitalisation (days) Follow‐up: 3 to 14 days | Mean length of hospitalisation in control groups was 10 days | Mean length of hospitalisation in intervention groups was 0.61 lower (1.51 lower to 0.28 higher) | 421 (3 studies) | ⊕⊕⊕⊝ Moderatea | ||
| Lung function (end of treatment) FEV1 (L) Follow‐up: 10 to 14 days | Mean FEV1 in control groups ranged from 0.84 to 1.14 L | Mean lung function (end of treatment) in intervention groups was 0.04 lower (0.19 lower to 0.10 higher) | 187 (4 studies) | ⊕⊝⊝⊝ Very lowa,c,d,e | ||
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Health‐related quality of life (QOL) Overall score (includes activity limitations, symptoms, fatigue, emotional functioning); scale 0 best to 6 worst; minimum important difference 0.5 Follow‐up: 30 days |
Mean QOL score in control groups was 1.24 | Mean QOL score in intervention groups was 0.06 higher (‐0.16 lower to 0.28 higher) | 271 (1 study) | ⊕⊕⊕⊝ Moderatea | ||
| *The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio. | ||||||
| GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aWide confidence intervals include significant benefit or harm (‐1 for imprecision). bParticipants and physicians not blinded to treatment in one study (‐1 for risk of bias). cParticipants and physicians not blinded to treatment in one study; however risk of bias for the outcome measurement is considered low. dHigh risk of attrition bias in one study (‐1 for risk of bias). eSignificant unexplained heterogeneity (‐1 for inconsistency).