Corticosteroids in Patients Hospitalized With Community-Acquired Pneumonia: Systematic Review and Individual Patient Data Metaanalysis

Abstract

Adjunct corticosteroids for patients hospitalized with CAP reduce time to clinical stability and length of hospital stay by approximately 1 day without a significant effect on overall mortality but with an increased risk for CAP-related rehospitalization and hyperglycemia.

Issues in Community-Acquired Pneumonia

“…Thus, it would be premature to use steroids routinely in severe CAP, pending larger RCT in this subgroup of patients admitted to hospital. In the most recent review and meta-analysis of steroids in hospitalized patients with CAP, with analysis of 1506 cases from six trials, steroids reduced time to clinical stability and length of hospital stay by 1 day but did not reduce mortality and increased risk of hyperglycemia and CAP-related rehospitalization [86]. The state of the art is reminiscent of the data of steroids in sepsis/septic shock, when steroids appeared to be effective in reducing mortality based on small RCTs but was proven ineffective in larger, definitive trials.…”

Corticosteroids and pneumonia – targeting the ideal candidate

“…Briel et al [21] used a slightly different methodology -individual patient data metaanalysis -that offers the advantage of standardized definitions and adjustments for variation on individual prognosis at baseline. With this approach, only 6 randomized trials were included, and patients in both arms were 748 vs. 758 representing 88.4% of the eligible population.…”

Cytokines and Cortisol – predictors of treatment response to corticosteroids in community‐acquired pneumonia?

“…Adjunctive therapy with corticosteroids has shown to be beneficial in patients with community‐acquired pneumonia (CAP) reducing time to clinical stability (TTCS) and length of hospital stay, and possibly reducing mortality . However, treatment with corticosteroids bears the risk for hyperglycaemia and might increase hospital re‐admissions .…”

“…Adjunctive therapy with corticosteroids has shown to be beneficial in patients with community‐acquired pneumonia (CAP) reducing time to clinical stability (TTCS) and length of hospital stay, and possibly reducing mortality . However, treatment with corticosteroids bears the risk for hyperglycaemia and might increase hospital re‐admissions . An early and accurate risk‐benefit stratification is therefore warranted to identify those patients who are most likely to benefit from adjunctive corticosteroids to improve outcome of CAP .…”