Corticosteroids Improved Outcomes, Recovery from Community Acquired Pneumonia

[[{"type":"media","view_mode":"media_crop","fid":"40930","attributes":{"alt":"Corticosteroid therpay for CAP","class":"media-image media-image-right","id":"media_crop_8035553795484","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4250","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 297px; width: 265px; float: right;","title":"©PuwadolJaturawattichai/Shutterstock.com ","typeof":"foaf:Image"}}]]Use of corticosteroids significantly reduced mortality, need for mechanical ventilation, and length of hospital stay among patients with community-acquired pneumonia (CAP), according to the results of a meta-analysis published recently in Annals of Internal Medicine.

Looking at data from almost 2,000 patients, Reed A.C. Siemienuik, MD, of McMaster University, and colleagues found that the use of systemic corticosteroids reduced mortality by about 3% among hospitalized patients with CAP.  

The authors suggest that this class of drugs is worth consideration, particularly for the sickest patients.

According to the review, current clinical practice guidelines do not support the use of systemic corticosteroids in patients with community-acquired pneumonia. The meta-analysis incorporated the most recently published randomized trials where corticosteroids were used in this patient population to determine if systemic use was linked with improved outcomes.

The researchers looked at 13 randomized trials of systemic corticosteroid use in hospitalized patients with CAP, including 9 trials not included in the last published meta-analysis of this topic.

Twelve trials examined all-cause mortality. Based on data from these trials, adjunctive corticosteroids were associated with a reduction in all-cause mortality: 7.9% of patients died in the control groups compared with 5.3% in the corticosteroid groups (risk ratio [RR]=0.67; 95% confidence interval [CI], 0.45-1.01).

“Our meta-analysis showed a possible reduction in mortality with the use of corticosteroids, but the certainty of this effect for all patients is diminished by the fact that it seemed to be driven by the subgroup of trials examining severe pneumonia,” the researchers wrote.

They also found an approximate 5% reduction in the need for mechanical ventilation (RR=0.45 95% CI, 0.26-0.79) and about a 6% reduction in acute respiratory distress syndrome (RR=0.24; 95% CI, 0.10-0.56) among patients assigned corticosteroids.

Looking at data from two of three studies with low bias that examined length of hospital stay, the researchers found a statistically significant median reduction in hospitalization of 1 day for patients assigned to systemic corticosteroids. 

Overall, the use of corticosteroids was associated with about a 4% increase in the incidence of hyperglycemia.

Siemieniuk and colleagues acknowledged several limitations to the study including the fact that the trials included in the analysis used “various agents, routes of administration, and doses of corticosteroids.”

Because of these limitations, “larger pragmatic trials could improve certainty associated with several important outcomes, including mortality, need for mechanical ventilation, acute respiratory distress syndrome, gastrointestinal bleeding, and neuropsychiatric disturbance.”

References:

Siemieniuk RAC, Meade MO, Alonso-Coello P, et al. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: a systematic review and meta-analysis. Ann Intern Med. 2015 Aug 11. doi: 10.7326/M15-0715.