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Name of Media:
Corticosteroids in Patients Hospitalized With Community-Acquired Pneumonia: Systematic Review and Individual Patient Data Meta analysis
Author(s):
Matthias Briel, Simone M C Spoorenberg, Dominic Snijders, Antoni Torres, Silvia Fernandez-Serrano, G Umberto Meduri, Albert Gabarrús, Claudine A Blum, Marco Confalonieri, Benjamin Kasenda, Reed AC Siemieniuk, Wim Boersma, Willem Jan W Bos, Mirjam Christ-Crain, Ovidius Study Group, Capisce Study Group and STEP Study Group
Publisher or Source:
Clinical Infectious Diseases
Type of Media:
Medical Journal
Media Originally for:
Critical Care Physicians
Country of Origin:
Canada
Primary Focus of Media:
Pre-Use of PICS Designation
COVID-19 Related:
No
Description:
Background
Our aim was to evaluate the benefits and harms of adjunctive corticosteroids in adults hospitalized with community-acquired pneumonia (CAP) using individual patient data from randomized, placebo-controlled trials and to explore subgroup differences.
Methods
We systematically searched Medline, Embase, Cochrane Central, and trial registers (all through July 2017). Data from 1506 individual patients in 6 trials were analyzed using uniform outcome definitions. We investigated prespecified 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], .46 to 1.21; P = .24). Time to clinical stability and length of hospital stay were reduced by approximately 1 day with corticosteroids (–1.03 days; 95% CI, –1.62 to –.43; P = .001 and –1.15 days; 95% CI, –1.75 to –.55; P < .001, respectively). More patients with corticosteroids had hyperglycemia (160 [22.1%] vs 88 [12.0%]; aOR, 2.15; 95% CI, 1.60 to 2.90; P < .001) and CAP-related rehospitalization (33 [5.0%] vs 18 [2.7%]; aOR, 1.85; 95% CI, 1.03 to 3.32; P = .04). 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 1 day without a significant effect on overall mortality but with an increased risk for CAP–related rehospitalization and hyperglycemia.
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