Corticosteroids in Patients Hospitalized With Community-Acquired Pneumonia: Systematic Review and Individual Patient Data Metaanalysis.

Abstract

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 &#x003D; .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 &#x003D; .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 &#x003D; .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.

• Authors: 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 A C Siemieniuk, Wim Boersma, Willem Jan W Bos, Mirjam Christ-Crain, Ovidius Study Group, Capisce Study Group, STEP Study Group
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 66 Issue 3 Pg. 346-354 (01 18 2018) ISSN: 1537-6591 [Electronic] United States
• PMID: 29020323 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Chemical References

• Adrenal Cortex Hormones

Topics

• Adrenal Cortex Hormones (adverse effects, therapeutic use)
• Age Factors
• Community-Acquired Infections (drug therapy, mortality)
• Hospitalization (statistics & numerical data)
• Humans
• Hyperglycemia (etiology)
• Length of Stay (statistics & numerical data)
• Odds Ratio
• Pneumonia (drug therapy, mortality)
• Randomized Controlled Trials as Topic
• Regression Analysis
• Risk Factors
• Severity of Illness Index