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Table 1 Studies on corticosteroids in CAP

From: New aspects in the management of pneumonia

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
  1. ARDS acute respiratory distress syndrome, CAP community acquired pneumonia, CI confidence interval, OR odds ratio, RCT randomized controlled trial, RR relative risk