OBJECTIVES : The objectives were to assess the efficacy and safety of methylprednisolone or dexamethasone in treatment of ASCI.

METHODS : A literature search was conducted on PubMed, EMBASE and Cochrane Library from their establishment date through 02/18/18 for studies evaluating the utility of steroids alone in ASCI. Pooled effect estimates were calculated using the random-effects model.

RESULTS : 2,956 articles were screened and 10 articles were included in the meta-analysis: three randomized controlled trials (RCTs) and seven observational studies. No article was found on dexamethasone that met the inclusion criteria. Comparing ASCI patients who received methylprednisolone alone to patients who received no treatment or other therapeutic agents results from the RCTs demonstrated overall standardized mean difference for motor score of 0.42 (95%CI=-0.47, 1.31) and pooled RR of 6.55 (95%CI=0.82, 52.6) for gastrointestinal related diseases; 0.97 (95%CI=0.54, 1.77) for urinary tract infection; 2.01 (95%CI=0.43, 9.40) for sepsis; and 0.99 (95%CI=0.48, 2.03) for pneumonia. Results from observational studies demonstrated that overall standardized mean difference for motor score was 0.66 (95%CI=-0.63, 1.95) and pooled RR was 2.12 (95%CI=0.98, 4.61) for gastrointestinal related diseases; 1.00 (95%CI=0.65, 1.53) for urinary tract infection; 1.41 (95%CI=0.39, 5.17) for sepsis; and 2.74 (95%CI=1.59, 4.73) for pneumonia.

CONCLUSIONS : In patients with ASCI, methylprednisolone in comparison with no treatment, placebo, or other therapeutic agents was not significantly associated with an improved motor score, improved urinary tract infection, worsened gastrointestinal related diseases, or worsened sepsis. The increased risk with pneumonia was only seen in observational studies and merits further investigation.