Table 1 Studies on corticosteroids in CAP
Reference | Study design and population | Main results |
|---|---|---|
Confalonieri et al. 2005 [15] | Multicenter RCT | Improvement in PaO2/FiO2 (p = 0.002), chest radiograph score (p < 0.0001), reduction in C-reactive protein levels (p = 0.01), delayed septic shock (p = 0.001), reduction in length of hospital stay (p = 0.03), and mortality (p = 0.009) |
Hydrocortisone versus placebo | ||
Patients with severe CAP | ||
Garcia-Vidal et al. 2007 [16] | Retrospective observational study | Systemic steroids were independently associated with decreased mortality (OR 0.287; 95 % CI 0.113–0.732). |
Patients with severe CAP | ||
Snijders et al. 2010 [17] | Unicentre RCT in Netherlands | Clinical cure at day 7 was 80.8 % in the prednisolone group and 85.3 % in the placebo group (p = 0.38) |
Prednisolone versus placebo | Clinical cure at day 30 was 66.3 % in the prednisolone group and 77.1 % in the placebo group (p = 0.08). | |
Hospitalized patients with CAP | Late failure (>72 h after admission) was more common in the prednisolone group than in the placebo group (19.2 versus 6.4 %, respectively; p = 0.04). | |
Meijvis et al. 2011 [18] | Bicenter RCT in Netherlands | Reduction in length of stay in dexamethasone group compared with the placebo group (6.5 versus 7.5 days, respectively; p = 0.048) |
Dexamethasone versus placebo | ||
Patients with CAP | ||
Chen et al. 2011 [19] | Meta-analysis | Accelerated the resolution of symptoms or time to clinical stability and decreased the rate of relapse of the disease |
Patients with pneumonia | ||
Nie et al. 2012 [20] | Meta-analysis | Corticosteroids did not significantly reduce mortality in the general population (Peto OR = 0.62, 95 % CI 0.37–1.04; p = 0.07). A survival benefit was found in a subgroup of patients with severe CAP (Peto OR = 0.26, 95 % CI 0.11–0.64; p = 0.003). |
Patients with CAP | ||
Shafiq et al. 2013 [21] | Meta-analysis | Reduced hospital length of stay with the use of corticosteroids (mean −1.21 days, 95 % CI –2.12 to −0.29) |
Patients with CAP | No effect on hospital mortality | |
Cheng et al. 2014 [22] | Meta-analysis | Use of corticosteroids significantly reduced hospital mortality compared with placebo (Peto OR = 0.39, 95 % CI 0.17–0.90) |
Patients with severe CAP | ||
Torres et al. 2015 [23] | Multicenter RCT in Spain | Corticosteroid treatment reduced the risk of treatment failure (OR = 0.34, 95 % CI 0.14–0.87; p = 0.02) |
Methylprednisolone versus placebo | In-hospital mortality did not differ between the two groups (10 % in the methylprednisolone group versus 15 % in the placebo group; p = 0.37) | |
Patients with severe CAP and high inflammatory response | ||
Blum et al. 2015 [24] | Multicenter RCT in Switzerland | Reduction of time to clinical stability in the prednisone group compared with the placebo group (3 days versus 4.4 days, respectively; p < 0.0001) |
Prednisolone versus placebo | ||
Patients with CAP | ||
Siemieniuk et al. 2015 [25] | Meta-analysis | Corticosteroids were associated with possible reductions in all-cause mortality (RR 0.67, 95 % CI 0.45–1.01), need for mechanical ventilation (RR 0.45, 95 % CI 0.26–0.79], and ARDS (RR 0.24, 95 % CI 0.10–0.56]). Corticosteroids decreased time to clinical stability (mean difference −1.22 days, 95 % CI −2.08 to −0.35 days), and duration of hospitalization (mean difference −1.00 day, 95 % CI −1.79 to −0.21 days) |
Patients with CAP | ||
Wan et al. 2016 [26] | Meta-analysis | Corticosteroids did not have an effect on mortality (RR 0.72, 95 % CI 0.43–1.21) in patients with CAP and patients with severe CAP (RCTs: RR 0.72, 95 % CI 0.43–1.21). Corticosteroid treatment was associated with a decreased risk of ARDS (RR 0.21, 95 % CI 0.08–0.59) |
Patients with CAP |