Efficacy and Safety of Adjunctive Corticosteroids Therapy for Severe Community-Acquired Pneumonia in Adults: An Updated Systematic Review and Meta-Analysis.

Jirui Bi,Ying Wang,Cijiang Yao,Youjin Lu,Jing Mei,Ying Liu,Jiyu Cao,Jin Yang,Cordula M Stover

doi:10.1371/journal.pone.0165942

Abstract

BackgroundAdjunctive corticosteroids therapy is an attractive option for community-acquired pneumonia (CAP) treatment. However, the effectiveness of adjunctive corticosteroids on mortality of CAP remains inconsistent, especially in severe CAP. We performed a meta-analysis to evaluate the efficacy and safety of adjunctive corticosteroids in severe CAP patients.MethodsThree databases of PubMed, EMBASE and Cochrane Library were searched for related studies published in English up to December, 2015. Randomized controlled trials (RCTs) of corticosteroids in hospitalized adults with severe CAP were included. Meta-analysis was performed by a random-effect model with STATA 11.0 software. We estimated the summary risk ratios (RRs) or effect size (ES) with its corresponding 95% confidence interval (95%CI) to assess the outcomes.ResultsWe included 8 RCTs enrolling 528 severe CAP patients. Adjunctive corticosteroids significantly reduced all-cause mortality (RR = 0.46, 95%CI: 0.28 to 0.77, p = 0.003), risk of adult respiratory distress syndrome (ARDS) (RR = 0.23, 95%CI: 0.07 to 0.80, p = 0.02) and need for mechanical ventilation (RR = 0.50, 95%CI: 0.27 to 0.92, p = 0.026). Adjunctive corticosteroids did not increase frequency of hyperglycemia requiring treatment (RR = 1.03, 95%CI: 0.61 to 1.72, p = 0.91) or gastrointestinal hemorrhage (RR = 0.66, 95%CI: 0.19 to 2.31, p = 0.52). In subgroup analysis by duration of corticosteroids, we found that prolonged corticosteroids therapy significantly reduced all-cause mortality (RR = 0.41, 95%CI: 0.20 to 0.83, p = 0.01) and length of hospital stay (−4.76 days, 95% CI:-8.13 to -1.40, p = 0.006).ConclusionsResults from this meta-analysis suggested that adjunctive corticosteroids therapy was safe and beneficial for severe CAP. In addition, prolonged corticosteroids therapy was more effective. These results should be confirmed by adequately powered studies in the future.

Highlights

Community-acquired pneumonia (CAP) is a common and serious infectious disease accompanied with high morbidity and mortality [1], about 20% of community-acquired pneumonia (CAP) adult patients acquire hospitalization, and has a mortality of 30–50% [2]
Adjunctive corticosteroids significantly reduced all-cause mortality (RR = 0.46, 95% confidence interval (95%confidence interval (CI)): 0.28 to 0.77, p = 0.003), risk of adult respiratory distress syndrome (ARDS) (RR = 0.23, 95%CI: 0.07 to 0.80, p = 0.02) and need for mechanical ventilation (RR = 0.50, 95%CI: 0.27 to 0.92, p = 0.026)
Corticosteroids and Severe Community-Acquired Pneumonia corticosteroids therapy significantly reduced all-cause mortality (RR = 0.41, 95%CI: 0.20 to 0.83, p = 0.01) and length of hospital stay (−4.76 days, 95% CI:-8.13 to -1.40, p = 0.006)

Summary

Introduction

Community-acquired pneumonia (CAP) is a common and serious infectious disease accompanied with high morbidity and mortality [1], about 20% of CAP adult patients acquire hospitalization, and has a mortality of 30–50% [2]. A recent study demonstrated that the raised levels of IL-6 and IL-10 were related with a high mortality in CAP, especially in severe CAP [8] which could potentially increase the incidences of sepsis, lung injury and acute respiratory distress syndrome (ARDS) [9]. Active and effective prevention of inflammatory deterioration is vital to severe CAP treatment. Adjunctive corticosteroids therapy is an attractive option for community-acquired pneumonia (CAP) treatment. The effectiveness of adjunctive corticosteroids on mortality of CAP remains inconsistent, especially in severe CAP. We performed a meta-analysis to evaluate the efficacy and safety of adjunctive corticosteroids in severe CAP patients

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