Corticosteroids improve outcomes in treatment of community-acquired pneumonia

1. From a systematic review, systemic corticosteroid use for community-acquired pneumonia decreased hospital length of stay, need for mechanical ventilation, and development of acute respiratory distress syndrome, but not mortality.

2. Corticosteroid use increased the incidence of hyperglycemia, but did not significantly increase incidence of other adverse effects.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Community-acquired pneumonia is one of the most common reasons for hospitalization among American adults. Recently, steroid therapy has been proposed as a potential treatment of pneumonia, but studies have not produced consistent results. This systematic review analyzed data from several previous trials of steroid therapy in addition to standard antibiotic therapy for treatment of pneumonia in hospitalized patients. Overall, steroid use was associated with decreased length of stay in the hospital, need for a ventilator to assist with breathing, and development of acute respiratory distress syndrome (ARDS). There was also a trend towards decreased all-cause mortality in patients who received steroids. While patients who received steroids had higher rates of hyperglycemia requiring treatment, they did not experience significantly higher rates of other potential side effects of steroid therapy. One notable limitation of this study is that the trials included frequently excluded patients with other conditions that would predispose them to negative outcomes or significant side effects from steroids. Furthermore, the included studies used a variety of different types of steroids, leaving the most effective type, dosing, and duration of steroids unknown. Nevertheless, this analysis provides compelling evidence for the potential usefulness of steroid therapy in the treatment of patients hospitalized with community-acquired pneumonia.

Click to read the study, published today in Annals of Internal Medicine

Relevant Reading: Incidence and Cost of Pneumonia in Medicare Beneficiaries

In-Depth [systematic review and meta-analysis]: This systematic review and meta-analysis evaluated randomized trials of adjunctive systemic corticosteroids versus no steroids or placebo in the treatment of patients hospitalized with community-acquired pneumonia. Thirteen studies were included. Corticosteroids were decreased the need for mechanical ventilation (RR 0.45; 95%CI 0.26-0.79), development of ARDS (RR 0.24; 95%CI 0.10-0.56), and reduced hospital length of stay by approximately 1 day (95%CI -1.79 to -0.21 days). Although it did not reach statistical significance, there was a trend towards decreased all-cause mortality in patients who received corticosteroids (RR 0.67; 95%CI 0.45-1.01). Corticosteroid use increased the incidence of hyperglycemia requiring treatment (RR 1.49; 95%CI 1.01-2.19), but did not increase the risk of gastrointestinal hemorrhage, severe neuropsychiatric complications, or re-hospitalization, although most of the included studies excluded patients at high-risk for these complications. Even after combining studies, these results were based on a small number of total events for each outcome.

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