Corticosteroids Improve Outcomes in Patients Hospitalized with Community-Acquired Pneumonia

By Kelly Young

Adjunctive corticosteroids are associated with some clinical improvements in patients hospitalized with community-acquired pneumonia, according to an Annals of Internal Medicine review.

The analysis included 13 trials comprising roughly 2000 patients with community-acquired pneumonia who were randomized to corticosteroids (oral or intravenous) or placebo.

Compared with placebo recipients, corticosteroid recipients were at significantly lower risk for requiring mechanical ventilation (risk ratio, 0.45) and for acute respiratory distress syndrome (RR, 0.24). In addition, duration of hospital stay and time to clinical stability were each reduced by about 1 day in the corticosteroid group. A potential mortality benefit was seen with corticosteroids, but only among patients with severe pneumonia.

Editorialists conclude: "We believe that this meta-analysis supports the use of systemic corticosteroid therapy in [patients hospitalized with severe CAP], but who are these patients?" Aside from the obvious signs (e.g., need for mechanical ventilation), they argue for the use of biomarkers, including C-reactive protein, to determine the extent of systemic inflammation.

Why We Chose This as Our Top Story:

Andre Sofair, MD, MPH: Although a meta-analysis, this study may provide evidence for adjunctive corticosteroid therapy in selected patients with severe community-acquired pneumonia. This may change practice.

Ref: Journal Watch

Aug 2015