Impact of Systemic Corticosteroids on the Outcome of Patients with Severe Community-Acquired Pneumonia: A Cohort Study.

Abstract

Rationale: Community−acquired pneumonia (CAP) is associated with significant morbidity and mortality in developed countries and recent guidelines suggest the benefit of systemic corticosteroids for patients with severe CAP. Yet few studies addressed this issue. The aim of the present study was to evaluate the impact of corticosteroids on the outcome of patients with CAP requiring intensive care. Methods: Retrospective cohort study segregating patients with CAP from two intensive care units (ICU). Patients were followed up from D1 till D7. Results: a total of 191 patients with severe CAP were included (median age 70 yrs, 21.9% hospital mortality). Corticosteroids were prescribed in 92 (48.1%) patients mainly for bronchospasm (50%) and septic shock (41.3%). Mortality rate of patients with and without corticosteroids was similar (25% vs 17.2%, p=0.28). Patients treated with corticosteroids were older and sicker, and presented a trend to increase of ICU−acquired infections (27.2% vs 16.2%, p=0.078). Clinical course (D1 to 7) assessed by SOFA score was similar (p=0.843); also C−reactive protein (CRP) declined likewise in both groups (p=0.374). Patients on corticosteroids were more frequently weaned of vasopressors by D5 (59.5% vs 15.3%, p=0.0004). Conclusions: In severe CAP patients the adjunctive therapy with corticosteroids had no major influence on mortality. No effects on SOFA and CRP courses were observed. If necessary, corticosteroid prescription seems to be safe in CAP patients. This abstract is funded by: CNPq, PRONEX.

Corticosteroids in Sepsis: Pathophysiological Rationale and the Selection of Patients

“…In one large observational study [63] and one randomized controlled trial [64], the adjunctive therapy with steroids had no significant influence on CRP course. In one large observational study [63] and one randomized controlled trial [64], the adjunctive therapy with steroids had no significant influence on CRP course.…”