Efficacy and Safety of Corticosteroids for Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis.
Chest. 2015 Oct 22;
Authors: Wan YD, Sun TW, Liu ZQ, Zhang SG, Wang LX, Kan QC
Background: Corticosteroids are an option in the treatment of community-acquired pneumonia (CAP). However, the benefits and adverse effects of corticosteroids, especially in severe CAP, have not been well assessed.
Methods: Pubmed, Embase, and Cochrane library databases from inception to May 2015 were searched. Randomized controlled trials (RCTs) and cohort studies that evaluated use of corticosteroids in adult patients with CAP were included. The quality of outcomes was evaluated using GRADE methodology. The Mantel-Haenszel method with random-effects modeling was used to calculate pooled relative risks (RRs) and 95% confidence intervals(CIs).
Results: Nine eligible RCTs (1667 patients) and six cohort studies(4095 patients), were identified. The mean corticosteroid dose and treatment duration were 30 mg/day methylprednisolone for 7 days. Corticosteroids did not have a statistically significant effect on mortality (RR, 0.72; 95% CI: 0.43-1.21; evidence rank: low) in CAP patients, and severe CAP patients (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 an decreased risk of adult respiratory distress syndrome (RR, 0.21; 95% CI, 0.08-0.59), and may reduce the lengths of hospital and intensive care unit stay, the duration of intravenous antibiotic treatment, and the time to clinical stability. Corticosteroid were not associated with increased rates of adverse events.
Conclusions: Short-term treatment with corticosteroids is safe, and may reduce the risk of adult respiratory distress syndrome, shorten the length of the disease in CAP patients.
PMID: 26501852 [PubMed - as supplied by publisher]