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Corticosteroids improve outcomes in patients with severe community-acquired pneumonia
Clinical Question
Do corticosteroids improve outcomes in patients with severe community-acquired pneumonia?
Bottom line
In this meta-analysis, patients with severe community-acquired pneumonia (CAP) treated with corticosteroids have lower mortality rates and shorter hospital lengths of stay than those not treated with the drugs, but no difference in overall treatment efficacy or time on ventilators. The authors don't report the potential harms of treatment. The existing research consists of a few small studies of limited quality, so these data may not hold up to scrutiny under large, well-conducted clinical trials. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Unknown/not stated
Setting: Various (meta-analysis)
Synopsis
These authors searched multiple databases to identify trials of corticosteroids as treatment for severe CAP. Two of the authors independently assessed each study for inclusion, and a third person resolved disagreements. They used a similar approach in applying the Jadad scale to assess the quality of the included studies. Ultimately, the authors included 10 small studies with a total of 368 control patients and 361 patients who received corticosteroids. The included studies used 4 different criteria for classifying patients with severe pneumonia and only 3 of the studies were considered to be of good quality. Seven trials reported that, on average, 12% of placebo-treated patients died in the hospital compared with 6% of corticosteroid-treated patients (number needed to treat = 16; 95% CI 10 - 62). Although the authors provide no operational definition of clinical efficacy, 6 trials reported no overall difference: approximately 75% of the patients improved whether or not they received steroids. Hospitalized patients treated with steroids had shorter lengths of stay than control patients. Among patients who needed mechanical ventilation, steroids made no difference in time on the ventilator. The authors don't address harms of treatment, and found varying degrees of statistical heterogeneity among the data.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
The ‘good news’ here is that patients in the placebo group were twice as likely to die as those receiving corticosteroids for severe CAP. I am motivated to learn more.
The larger question is in patients with CAP who are not sick enough to require hospitalization, are steroids helpful
The evidence is quite conflicting. Latest EMRAP said no benefit to corticosteroids in CAP.
good poem
Excellent
conflicting conclusions
There was another POEM recently which supported the use of corticosteroids with moderate / severe CAP, yet this review indicates no benefit (yet potential harm). Conflicting reporting.