Impact and indication of early systemic corticosteroids for very severe community-acquired pneumonia

Ugajin, Motoi; Yamaki, Kenichi; Hirasawa, Natsuko; Kobayashi, Takanori; Yagi, Takeo

doi:10.2147/ijgm.s49275

Cited by 4 publications

(1 citation statement)

References 31 publications

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“…Recent meta-analyses of randomised controlled trials found that even though low-dose corticosteroid use may not be beneficial to the overall population of patients with CAP, it may have a beneficial effect on mortality in patients with severe CAP and/or acute respiratory distress [13,[21][22][23]. However, recent small observational studies that focused on patients with severe CAP reported conflicting results [24][25][26]. Therefore, the effect of low-dose corticosteroid use on mortality in critically ill patients with severe CAP remains unclear.…”

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confidence: 99%

Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients

et al. 2014

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The relationship between low-dose corticosteroid use and mortality in patients with severe community-acquired pneumonia (CAP) remains unclear.6925 patients with severe CAP who received mechanical ventilation with or without shock (defined as use of catecholamines) at 983 hospitals were identified using a Japanese nationwide administrative database. The main outcome measure was 28-day mortality.2524 patients with severe CAP who received catecholamines were divided into corticosteroid (n=631) and control (n=1893) groups. The 28-day mortality was significantly different between corticosteroid and control groups (unmatched: 24.6% versus 36.3%, p<0.001; propensity score-matched: 25.3% versus 32.6%, p=0.01; inverse probability-weighted: 27.5% versus 34.2%, p<0.001). 4401 patients with severe CAP who did not receive catecholamines were also divided into corticosteroid (n=1112) and control (n=3289) groups. The 28-day mortality was not significantly different between corticosteroid and control groups in propensity score-matched analyses (unmatched: 16.0% versus 19.4%, p=0.01; propensity score-matched: 17.7% versus 15.6%, p=0.22; inverse probability-weighted: 18.8% versus 18.2%, p=0.44).Low-dose corticosteroid use may be associated with reduced 28-day mortality in patients with septic shock complicating CAP. @ERSpublications Low-dose corticosteroids in severe CAP patients was associated with better prognosis only in those with septic shock

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Section: Introductionmentioning

confidence: 99%

Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients

et al. 2014

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Beneficial effect of sequential treatment with high-dose steroids and short-course oral glucocorticoids in patients with severe influenza virus-associated pneumonia

Li,

Gao,

Hao

et al. 2024

Sci Rep

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Nonantibiotic Adjunctive Therapies for Community-Acquired Pneumonia (Corticosteroids and Beyond): Where Are We with Them?

Sibila

Rodrigo-Troyano

Torres

2016

Semin Respir Crit Care Med

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Community-acquired pneumonia (CAP) is a leading cause of hospitalization, morbidity, and mortality. Despite advances in antibiotic treatments, mortality among patients with CAP is still high. For this reason, interest has been focused on nonantibiotic therapeutic measures directed to the host response rather than the microorganism. The development of an efficacious adjunctive treatment has important implications for reducing mortality in CAP. Some clinical studies performed in the last decade have shown a clinically beneficial effect of corticosteroids, possibly by diminishing local and systemic inflammatory host response. Recent meta-analyses showed faster resolution of symptoms, shorter time to clinically stability, reduction of mechanical ventilation needed, and reduction of mortality in the most severe population, although some methodological limitations must be taken into account. In addition, some studies using statins also suggested improved outcomes due to its anti-inflammatory effect in CAP, although this requires further research. Other adjunctive therapies such as immunoglobulins and stem cells are being explored, but are not yet in the stage of clinical trials. In summary, the use of corticosteroids and other adjuvant treatments are promising in CAP, but more studies are needed to determine their impact on mortality.

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Impact and indication of early systemic corticosteroids for very severe community-acquired pneumonia

Cited by 4 publications

References 31 publications

Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients

Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients

Beneficial effect of sequential treatment with high-dose steroids and short-course oral glucocorticoids in patients with severe influenza virus-associated pneumonia

Nonantibiotic Adjunctive Therapies for Community-Acquired Pneumonia (Corticosteroids and Beyond): Where Are We with Them?

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