Steroids reduce ICU stay and mortality risk in severe community-acquired pneumonia

Chinese Researchers have found that systemic corticosteroids reduce the length of ICU stay and mortality risk in severe community-acquired pneumonia.

While antibiotics are the mainstay for treatment of community-acquired pneumonia (CAP), the systemic use of corticosteroids for severe CAP patients remains disputed in clinical practice. Putting an end to all controversies, a review has found that the adjunctive systemic corticosteroids therapy is effective and safe for patients with severe CAP.

Pneumonia is a leading cause of hospital admissions and health care resource consumption worldwide and in addition to influenza, remains the eighth leading cause of death in the United States. Because CAP is associated with significant morbidity and mortality, efforts to optimize the management of the infection are a top priority for organizations such as the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS).

Huang Jing, Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, and colleagues undertook this systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with severe CAP.

Nine trials which contained 914 patients were included for final meta-analysis. The endpoints of the study included total mortality, length of intensive care unit (ICU) stay and mechanical ventilation.

Also Read: Updated Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia

Key findings of the study include:

• Of the 488 patients in the corticosteroid group, there were 37 deaths (7.58%) and 56 deaths occurred in 426 patients in the control group (13.1%).


• Corticosteroid therapy was associated with a lower rate of all-cause mortality compared to control.


• Subgroup analysis was conducted to show that the drug type modified the effect of steroids for mortality rate: prednisolone or methylprednisolone therapy reduced total mortality, whereas hydrocortisone use did not.


• The length of ICU stay was significantly shorter in the steroid group compared to control (MD −2.52 days).


• There was a reduction trend in the need for mechanical ventilation in the corticosteroid group.


• There was no trend towards more adverse events in the corticosteroid arm compared to control.

Also Read: Are Steroids beneficial and safe in Pneumonia?

"Overall, adjunctive systemic corticosteroids therapy was effective and safe for patients with severe CAP. In addition, the effects of mortality may differ according to the type of corticosteroids," concluded the authors.

For detailed study follow the link: 10.1097/MD.0000000000014636