Corticosteroids halt progression of community acquired pneumonia to mechanical ventilation

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality. Corticosteroids may be a beneficial adjunct in the treatment of bacterial pneumonia.

PubMed, Cochrane Library and Embase were searched to identify randomized control trials (RCTs) assessing the use of systemic corticosteroids compared to standard care in the management of CAP. A systematic review, meta-analysis, and trial sequential analysis (TSA) were performed. The primary outcome was all-cause mortality. Secondary outcomes included intensive care unit admission, mechanical ventilation, treatment failure, readmission, and adverse events. Data are presented as relative risk (confidence intervals), p-value, heterogeneity (I2) and TSA-adjusted confidence intervals.

Results:

• Sixteen trials met the eligibility criteria. All-cause mortality, ICU admission, treatment failure and the incidence of adverse events were similar between patients receiving corticosteroids and patients assigned to the control group.
• The need for mechanical ventilation was lower among patients receiving corticosteroids compared to standard care.
• However, corticosteroid use might be associated with higher rates of hospital readmission

Corticosteroid therapy is associated with a lower incidence of progression to requiring mechanical ventilation among patients hospitalized with CAP. There was no association between corticosteroid therapy and mortality, treatment failure, or adverse events.

Reference:

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 meta-regression of randomized control trials. Chest. 2022 Sep 7:S0012-3692(22)03705-9. doi: 10.1016/j.chest.2022.08.2229. Epub ahead of print. PMID: 36087797