Corticosteroid Therapy for Severe Community-Acquired Pneumonia: A Meta-Analysis

Abstract

BACKGROUND:The debate about the efficacy of corticosteroids in the treatment of severe community-acquired pneumonia (CAP) is still a longstanding dilemma. We performed a meta-analysis including 4 randomized controlled trials (RCTs) to evaluate the effect of corticosteroids on the treatment of severe CAP in adults. METHODS: We performed a systematic review of published and unpublished clinical trials. Databases, including PubMed, Embase, CINAHL, and Cochrane (from their establishment to July 2013), were searched for relevant articles. Only RCTs of corticosteroids as adjunctive therapy in adult patients with severe CAP were selected. RESULTS: Four trials enrolling 264 patients with severe CAP were included. Use of corticosteroids significantly reduced hospital mortality compared with conventional therapy and placebo (Peto odds ratio ‫؍‬ 0.39, 95% CI 0.17-0.90). The quality of the evidence underlying the pooled estimate of effect on hospital mortality was low, downgraded for inconsistency and imprecision. CONCLUSIONS: On the basis of the current limited evidence, we suggest that, although corticosteroid therapy may reduce mortality and improve the prognosis of adult patients with severe CAP, the results should be interpreted with caution due to the instability of pooled estimates. Reliable treatment recommendations will be raised only when large sufficiently powered multi-center RCTs are conducted.

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

“…There has been longstanding debate regarding the benefit of low-dose corticosteroid use in patients with CAP, but no consensus has been reached [4,[13][14][15][16][17][18][19][20]. 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].…”

Pneumonia as an actual medical problem of the 21th century

“…В системном обзоре и метаанализе Ming Cheng et al [24] рассмотрена эффективность ГКС при тя желых формах приобретенной пневмонии, исходя из предпосылки, что тяжелая пневмония, которая яв ляется причиной острого повреждения легочной ткани, часто осложняется развитием респираторно го дистресс синдрома, а также сепсиса. Системная воспалительная реакция при пневмонии сопровож дается повышением активности провоспалительных цитокинов -интерлейкинов (IL) 6, 8, 10, 1β , TNF α, а также интерферона γ, экспрессия которых коррелирует со степенью тяжести течения пневмо нии.…”

Corticosteroids in the treatment of community-acquired pneumonia: an evidence summary

“…The mortality benefit of corticosteroids remains uncertain, and if it does exist, it may be restricted to patients with severe CAP. 35,36 This suggests that the most compelling indication for corticosteroid use may be in patients with more severe CAP.…”

“…The Italian trial almost certainly overestimated the effect size: the mortality rate was higher than expected in the placebo group, and the trial was stopped early for benefit without predefined stopping criteria. 30 Meta-analyses prior to the most recent trials Meta--analyses of corticosteroids for CAP have reported varying findings, some suggesting a mortality benefit in those with severe CAP, 35,36 with low--dose corticosteroids, 37 or with prolonged administration. 35 No studies found a significant mortality benefit across all patients with CAP.…”