Efficacy and safety of corticosteroids for community-acquired pneumonia: A systematic review and meta-analysis

You-Dong Wan, Tong-wen Sun, Zi-Qi Liu, Shu-Guang Zhang, Lexin Wang, Quan-Cheng Kan

Research output: Contribution to journalArticlepeer-review

95 Citations (Scopus)

Abstract

BACKGROUND:Corticosteroids are an option in the treatment of community-acquiredpneumonia (CAP). However, the benefits and adverse effects of corticosteroids, especiallyin severe CAP, have not been well assessed.
METHODS:PubMed, Embase, and Cochrane library databases from inception to May 2015were searched. Randomized controlled trials (RCTs) and cohort studies that evaluated use ofcorticosteroids in adult patients with CAP were included. The quality of outcomes wasevaluated using Grading of Recommendations Assessment, Development and Evaluationmethodology. The Mantel-Haenszel method with random-effects modeling was used tocalculate pooled relative risks (RRs) and 95% CIs.
RESULTS:Nine eligible RCTs (1,667 patients) and six cohort studies (4,095 patients) wereidentified. The mean corticosteroid dose and treatment duration were 30 mg/day methyl-prednisolone for 7 days. Corticosteroids did not have a statistically significant effect onmortality (RR, 0.72; 95% CI, 0.43-1.21; evidence rank, low) in patients with CAP and patientswith severe CAP (RCTs: RR, 0.72; 95% CI, 0.43-1.21; evidence rank, low; cohort studies: RR,1.00; 95% CI, 0.86-1.17 ). Corticosteroids treatment was associated with a decreased risk ofARDS (RR, 0.21; 95% CI, 0.08-0.59) and may reduce lengths of hospital and ICU stay,duration of IV antibiotic treatment, and time to clinical stability. Corticosteroids were notassociated with increased rates of adverse events.
CONCLUSIONS:Short-term treatment with corticosteroids is safe and may reduce the risk ofARDS, shortening the length of the disease in patients with CAP.
Original languageEnglish
Pages (from-to)209-219
Number of pages11
JournalChest
Volume149
Issue number1
DOIs
Publication statusPublished - Jan 2016

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