Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of systemic corticosteroids in the treatment of patients with severe community-acquired pneumonia (sCAP). Methods A comprehensive search was conducted using the Medline, Embase, ClinicalTrials.gov, and Scopus databases for articles published until April 24, 2023. Only randomized controlled trials (RCTs) that assessed the clinical efficacy and safety of adjunctive corticosteroids for treating sCAP were included. The primary outcome was the 30-day all-cause mortality. Results A total of severe RCTs involving 1689 patients were included in this study. Overall, the study group had a lower mortality rate at day 30 than the control group (risk ratio [RR], 0.61; 95% CI 0.44 to 0.85; p < 0.01) with low heterogeneity (I2 = 0%, p = 0.42). Compared to the control group, the study group had a lower risk of the requirement of mechanical ventilation (RR 0.57; 95% CI 0.45 to 0.73; p < 0.001), shorter length of intensive care unit (MD − 0.8; 95% CI − 1.4 to − 0.1; p = 0.02), and hospital stay (MD − 1.1; 95% CI − 2.0 to − 0.1; p = 0.04). Finally, no significant difference was observed between the study and the control groups in terms of gastrointestinal tract bleeding (RR 1.03; 95% CI 0.49 to 2.18; p = 0.93), healthcare-associated infection (RR 0.89; 95% CI 0.60 to 1.32; p = 0.56), and acute kidney injury (RR 0.68; 95% CI 0.21 to 2.26; p = 0.53). Conclusions In patients with sCAP, adjunctive corticosteroids can provide survival benefits and improve clinical outcomes without increasing adverse events. However, because the pooled evidence remains inconclusive, further studies are required.

Mitochondrial dysfunction precedes hippocampal IL-1β transcription and cognitive impairments after low-dose lipopolysaccharide injection in aged mice

“…Systemic inflammation originating from peripheral organs can activate microglia and initiate neuroinflammation via various pathways, including afferent nerve inputs, interaction between circulating immune mediators and endothelial cells, and active transport of proinflammatory cytokines and cells through the BBB (blood brain barrier) [ 20 ]. While it may be possible to reduce delirium by using anti-inflammatory agents, anti-inflammatory treatment itself can also increase the incidence of infection [ 21 ]. Therefore, there is a need to identify potential therapeutic targets with fewer adverse complications.…”

Corticosteroids for infectious critical illness: A multicenter target trial emulation stratified by predicted organ dysfunction trajectory

“…However, the benefits of corticosteroid treatment in infectious critical illness are to be balanced with immunosuppression, hyperglycemia, and other adverse events [8][9][10] . There remains an unmet need to establish a more precise target population within infectious critical illness to improve the risk benefit profile of corticosteroid therapy 7,[11][12][13] .…”

Evidence supports the use of hydrocortisone for patients with community-acquired pneumonia

“…Chiang et al have given a closer look at the evidence regarding the effects of corticosteroids on severe community-acquired pneumonia (CAP) [ 1 ], and the article is a correspondence of a synthesis by Wu et al [ 2 ]. In contrast with the initial synthesis, Dr. Chiang et al added three relevant trials and distinctively analyzed five studies utilizing hydrocortisone from another set of five studies employing non-hydrocortisone corticosteroids.…”

“…The data presented in the present correspondence were extracted from both the original synthesis and a preceding communication [ 1 , 2 ]. Our analysis employed methodologies consistent with the previous analyses.…”

“…The results were reported with a 95% confidence interval (CI). As for the supplementary sequential analysis, it was conducted with a specified type I error of 0.05, a power of 0.80, and a 20% relative risk reduction (RRR), aligning with parameters established in the original synthesis [ 2 ]. Incidence in control arm was also obtained from pooled analysis.…”