Systemic corticosteroids for community-acquired pneumonia in adults

Introduction

We aimed to evaluate evidence from randomised controlled trials (RCTs) investigating the effect of systemic corticosteroids in adults with community-acquired pneumonia (CAP). Observational data suggest that corticosteroids may decrease mortality in severe CAP [1], and several large RCTs have been published since the recent Cochrane review [2].

Methods

A systematic review of the literature: Cochrane Central Register for Controlled Clinical Trials, MEDLINE, EMBASE and SCOPUS, and reference lists of original studies and reviews. Data were collated and analysed using Review Manager v5.1.

Results

A total of 254 RCTs were identified. Seven met inclusion criteria, totalling 806 patients. Studies varied in methodology, participants, interventions, and outcome measures. Where meta-analysis was possible, data are presented in Table 1 (outcomes: hospital mortality, 30-day mortality, hospital length of stay, superinfection, hyperglycaemia). Excepting hyperglycaemia, effect estimates were not statistically significant. Two small studies (n = 46 and n = 30) concentrated on severe CAP (using ATS and BTS criteria); one study found a statistically significant reduction in mortality, lengths of stay and duration of mechanical ventilation in the steroid group, but similar improvements in the other study, and in a large subgroup of patients with severe CAP in another study (n = 93) were not found. Significant reductions in inflammatory markers in the week following initiation of steroid treatment were found in six studies.

Table 1 Meta-analysis of clinical outcomes

Conclusion

Systemic corticosteroid administration as adjunctive treatment for CAP does not appear to improve relevant clinical outcomes, regardless of severity, and is associated with significantly increased incidence of hyperglycaemia.