Uso de corticoides sistémicos en pacientes adultos hospitalizados por neumonía adquirida en la comunidad

Abstract

Community-acquired pneumonia (CAP) is a common and serious infectious disease accompanied with high morbidity and mortality. Corticosteroids (CS) therapy has been proposed for community-acquired pneumonia hospitalized adult patients. However, the effectiveness of adjunctive corticosteroids on relevant clinical outcomes of CAP remains inconsistent. Objectives: We assessed the efficacy and safety of adjunctive corticosteroids therapy in severe CAP patients. Methods: Five databases: PubMed, Scielo, Epistemonikos, Lilacs and Cochrane Library were searched for related studies published up to June, 2018. Randomized controlled trials (RCTs) of corticosteroids in hospitalized adults with severe CAP were included. Results: We assessed ten systematic reviews and fifteen primary studies enrolling severe CAP hospitalized patients. Corticosteroids therapy significantly reduced all-cause mortality (risk ratio (RR): 0.58; 95%CI: 0.40 to 0.84), early clinical failure (RR: 0.32; 95%CI: 0.15 to 0.7), risk of adult respiratory distress syndrome (ARDS) (RR: 0.23; 95%CI: 0.07 to 0.80), need for mechanical ventilation (RR: 0.40; 95%CI: 0.20 to 0.77) and decreased hospital length of stay (mean difference: −2.91 days; 95%CI: −4.92 to −0.89). Corticosteroids therapy increased hyperglycemia risk (RR: 1.72; 95%CI: 1.38 to 2.14) but not gastrointestinal hemorrhage frequency (RR: 0.91; 95%CI: 0.40 to 2.05). Conclusions: Adjuvant therapy with systemic corticosteroids decreases mortality, risk of hospital complications and shortens hospital length of stay in patients with severe CAP. These results should be confirmed by adequately powered studies in the future.