EXPLORING THE ROLE OF ADJUNCT CORTICOSTEROID THERAPY TO DECREASE COMMUNITY-ACQUIRED PNEUMONIA-RELATED COMPLICATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

SESSION TITLE: Outcomes in Pneumonia and NTMSESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/17/2022 12:15 pm - 1:15 pmPURPOSE: Adjunct corticosteroid therapy to patients with community-acquired pneumonia (CAP) remains controversial in clinical practice. We performed an updated systematic review and meta-analysis to assess the efficacy of corticosteroids in decreasing complications of CAP such as ARDS, empyema, shock, and pleural effusion.METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus for randomized controlled trials (RCT) from each database’s inception to February 2022. We estimated the summary risk ratios (RR) with their corresponding 95% confidence interval (CI) through random effects Mental-Haenszel model. Subgroup analyses were also conducted. I-squared statistics (I2) were used to evaluate heterogeneity. Publication bias was assessed with Begg’s tests.RESULTS: We included 11 RCTs containing 3,509 patients with CAP. Adjunctive corticosteroid therapy was associated with significant reduction in CAP-related complications (RR = 0.73, CI 0.55 – 0.97, p = 0.015, I2 = 56.9%). In subgroup analysis, patients who received higher dose of steroids (> 50 mg prednisone equivalents/day) had a more significant reduction in CAP-related complications (RR = 0.46, CI = 0.31 – 0.68, p = 0.001, I2 = 12.2%). No significant publication bias was observed with Begg’s test (p = 0.087).CONCLUSIONS: This meta-analysis indicates that adjunctive corticosteroids significantly reduce CAP-related complications.CLINICAL IMPLICATIONS: Adjunctive corticosteroid therapy is a plausible option to limit complications such as ARDS, empyema, shock, and pleural effusion in CAP patients with co-morbidities and who are at high risk for clinical deterioration.DISCLOSURES: No relevant relationships by Mubashir Ayaz AhmedNo relevant relationships by Shayet Hossain EshanNo relevant relationships by Sami HusseinNo relevant relationships by Mohammed HusseinNo relevant relationships by Jose Medina InojosaNo relevant relationships by Wasey Ali Yadullahi MirNo relevant relationships by Sudha MisraNo relevant relationships by Kamalnath Sankaran RajagopalanNo relevant relationships by Chenyu Sun SESSION TITLE: Outcomes in Pneumonia and NTM SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Adjunct corticosteroid therapy to patients with community-acquired pneumonia (CAP) remains controversial in clinical practice. We performed an updated systematic review and meta-analysis to assess the efficacy of corticosteroids in decreasing complications of CAP such as ARDS, empyema, shock, and pleural effusion. METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus for randomized controlled trials (RCT) from each database’s inception to February 2022. We estimated the summary risk ratios (RR) with their corresponding 95% confidence interval (CI) through random effects Mental-Haenszel model. Subgroup analyses were also conducted. I-squared statistics (I2) were used to evaluate heterogeneity. Publication bias was assessed with Begg’s tests. RESULTS: We included 11 RCTs containing 3,509 patients with CAP. Adjunctive corticosteroid therapy was associated with significant reduction in CAP-related complications (RR = 0.73, CI 0.55 – 0.97, p = 0.015, I2 = 56.9%). In subgroup analysis, patients who received higher dose of steroids (> 50 mg prednisone equivalents/day) had a more significant reduction in CAP-related complications (RR = 0.46, CI = 0.31 – 0.68, p = 0.001, I2 = 12.2%). No significant publication bias was observed with Begg’s test (p = 0.087). CONCLUSIONS: This meta-analysis indicates that adjunctive corticosteroids significantly reduce CAP-related complications. CLINICAL IMPLICATIONS: Adjunctive corticosteroid therapy is a plausible option to limit complications such as ARDS, empyema, shock, and pleural effusion in CAP patients with co-morbidities and who are at high risk for clinical deterioration. DISCLOSURES: No relevant relationships by Mubashir Ayaz Ahmed No relevant relationships by Shayet Hossain Eshan No relevant relationships by Sami Hussein No relevant relationships by Mohammed Hussein No relevant relationships by Jose Medina Inojosa No relevant relationships by Wasey Ali Yadullahi Mir No relevant relationships by Sudha Misra No relevant relationships by Kamalnath Sankaran Rajagopalan No relevant relationships by Chenyu Sun