Although adjunctive systemic corticosteroid therapy was found to decrease the risk for requiring mechanical ventilation in patients with community-acquired pneumonia (CAP), corticosteroids did not significantly alter the risk for all-cause mortality, treatment failure, or adverse event occurrence compared with standard care. These study findings were published in CHEST.
Researchers in London conducted a systematic review and meta-analysis of 16 randomized controlled trials (RCTs) sourced from PubMed, Cochrane Library, and Embase to compare the effects of adjunctive systemic corticosteroid therapy with standard care in patients with bacterial CAP. The primary outcome was all-cause mortality; secondary outcomes included intensive care unit (ICU) admission, mechanical ventilation, treatment failure, hospital readmission, and the occurrence of adverse events (AEs). Risk ratios [RRs] were assessed using a random-effects model with the generic Mantel-Haenszel method.
Among a total of 3863 patients included in all 16 RCTs, all-cause mortality outcomes were reported for 3842. Of these patients, 1910 received systemic corticosteroids and 1932 received standard care. The researchers found that all-cause mortality rates did not significantly differ between patients in the corticosteroids vs standard care groups (9.5% vs 10.8%; RR, 0.85; 95% CI, 0.67-1.07; P =.17).
The researchers assessed patients in the corticosteroid vs standard care groups with outcome data on ICU admissions (n=1301 vs n=1318), need for mechanical ventilation (n=737 vs n=720), hospital readmission (n=1422 vs n=1431), and treatment failure (n=1037 vs n=1056).
They found that patients in the corticosteroid vs standard care groups had lower rates of ICU admission (3.1% vs 4.7%; RR, 0.66; 95% CI, 0.45-0.97; P =.04) and need for mechanical ventilation (4.2% vs 7.1%; RR, 0.51; 95% CI, 0.33-0.77; P =.001), but not hospital readmission (21.5% vs 17.7%; RR, 1.20; 95% CI, 1.05-1.38; P =.008). In addition, treatment failure rates were not significantly different between patients who received corticosteroids vs standard care (5.3% vs 5.7%; RR, 0.78; 95% CI, 0.37-1.67; P =.52).
Further analysis was performed to assess patients in the corticosteroids (n=1212) vs standard care (n=1275) groups with data on AEs. There was no significant increase in the risk for any AE among patients who received corticosteroids vs standard care (55.8% vs 48.5%; RR, 1.10; 95% CI, 0.97-1.25; P =.14).
These findings may only be generalizable to patients hospitalized with CAP of bacterial origin.
“[A]djuvant systemic corticosteroid therapy in patients hospitalized with bacterial pneumonia may prevent the requirement for mechanical ventilation,” the researchers concluded.
Saleem N, Kulkarni A, Chandos Snow TA, Ambler G, Singer M, Arulkumaran N. Effect of corticosteroids on mortality and clinical cure in community-acquired pneumonia: a systematic review, meta-analysis, and metaregression of randomized control trials. Chest. Published online September 7, 2022. doi:10.1016/j.chest.2022.08.2229