Corticosteroids in the treatment of community-acquired pneumonia in adults: a meta-analysis

PLoS One. 2012;7(10):e47926. doi: 10.1371/journal.pone.0047926. Epub 2012 Oct 24.

Abstract

Background: The benefit of corticosteroids in community-acquired pneumonia (CAP) remains controversial. We did a meta-analysis to include all the randomized controlled trials (RCTs) which used corticosteroids as adjunctive therapy, to examine the benefits and risks of corticosteroids in the treatment of CAP in adults.

Methods: Databases including Pubmed, EMBASE, the Cochrane controlled trials register, and Google Scholar were searched to find relevant trials. Randomized and quasi-randomized trials of corticosteroids treatment in adult patients with CAP were included. Effects on primary outcome (mortality) and secondary outcomes (adverse events) were accessed in this meta-analysis.

Results: Nine trials involving 1001 patients were included. Use of corticosteroids did not significantly reduce mortality (Peto odds ratio [OR] 0.62, 95% confidence interval [CI] 0.37-1.04; P = 0.07). In the subgroup analysis by the severity, a survival benefit was found among severe CAP patients (Peto OR 0.26, 95% CI 0.11-0.64; P = 0.003). In subgroup analysis by duration of corticosteroids treatment, significant reduced mortality was found among patients with prolonged corticosteroids treatment (Peto OR 0.51, 95% CI 0.26-0.97; P = 0.04; I(2) = 37%). Corticosteroids increased the risk of hyperglycemia (Peto OR 2.64, 95% CI 1.68-4.15; P<0.0001), but without increasing the risk of gastroduodenal bleeding (Peto OR 1.67, 95% CI 0.41-6.80; P = 0.47) and superinfection (Peto OR 1.36, 95% CI 0.65-2.84; P = 0.41).

Conclusion: Results from this meta-analysis did not suggest a benefit for corticosteroids treatment in patients with CAP. However, the use of corticosteroids was associated with improved mortality in severe CAP. In addition, prolonged corticosteroids therapy suggested a beneficial effect on mortality. These results should be confirmed by future adequately powered randomized trials.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Community-Acquired Infections / drug therapy*
  • Community-Acquired Infections / mortality
  • Humans
  • Hyperglycemia / chemically induced
  • Pneumonia / drug therapy*
  • Survival Analysis

Substances

  • Adrenal Cortex Hormones

Grant support

This study was supported by grant no. 81170025 from the National Natural Science Foundation of China and projects of "Major New Drugs Innovation and Development" from the National Ministry of Science and Technology (no. 2011ZX09302-003-001). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.