Corticosteroids in patients hospitalized with community-acquired pneumonia: systematic review and individual patient data meta-analysis.
Clin Infect Dis. 2017 Sep 09;:
Authors: Briel M, Spoorenberg SMC, Snijders D, Torres A, Fernandez-Serrano S, Meduri GU, Gabarrús A, Blum CA, Confalonieri M, Kasenda B, Siemieniuk RAC, Boersma W, Bos WJW, Christ-Crain M, Ovidius study group, Capisce study group, STEP study group
Abstract
Background: We aimed to evaluate the benefits and harms of adjunctive corticosteroids in adults hospitalized with community-acquired pneumonia (CAP) using individual patients' data of randomized placebo-controlled trials and to explore subgroup differences.
Methods: We systematically searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and trial registers (all until July 2017) for eligible trials. Data from 1,506 individual patients in six trials were analyzed using uniform outcome definitions. We investigated pre-specified effect modifiers using multivariable hierarchical regression adjusting for pneumonia severity, age, and clustering effects.
Results: Within 30 days of randomization, 37 of 748 patients (5.0%) assigned to corticosteroids and 45 of 758 patients (5.9%) assigned to placebo died (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.46-1.21, p=0.24). Time to clinical stability and length of hospital stay were reduced by approximately one day with corticosteroids (-1.03 days; 95% CI, -1.62-(-0.43), p=0.001; and -1.15 days; 95% CI, -1.75-(-0.55), p<0.001, respectively). More patients with corticosteroids had hyperglycaemia requiring insulin treatment (160 [22.1%] vs 88 [12.0%]; aOR, 2.15; 95% CI, 1.60-2.90, p<0.001; number needed to harm [NNH], 9; 95% CI 6-17) and CAP-related re-hospitalization (33[5.0%] vs 18[2.7%]; aOR, 1.85; 95% CI, 1.03-3.32, p=0.04; NNH, 45; 95% CI 18-1235). We did not find significant effect modification by CAP severity or degree of inflammation.
Conclusions: Adjunct corticosteroids for patients hospitalized with CAP reduce time to clinical stability and length of hospital stay by approximately one day without a significant effect on overall mortality but with an increased risk for CAP-related rehospitalisation and hyperglycaemia.
PMID: 29020323 [PubMed - as supplied by publisher]