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Efficacy and Safety of Adjunctive Corticosteroids Therapy for Severe Community-Acquired Pneumonia in Adults: An Updated Systematic Review and Meta-Analysis

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  • Jirui Bi
  • Jin Yang
  • Ying Wang
  • Cijiang Yao
  • Jing Mei
  • Ying Liu
  • Jiyu Cao
  • Youjin Lu

Abstract

Background: Adjunctive corticosteroids therapy is an attractive option for community-acquired pneumonia (CAP) treatment. However, the effectiveness of adjunctive corticosteroids on mortality of CAP remains inconsistent, especially in severe CAP. We performed a meta-analysis to evaluate the efficacy and safety of adjunctive corticosteroids in severe CAP patients. Methods: Three databases of PubMed, EMBASE and Cochrane Library were searched for related studies published in English up to December, 2015. Randomized controlled trials (RCTs) of corticosteroids in hospitalized adults with severe CAP were included. Meta-analysis was performed by a random-effect model with STATA 11.0 software. We estimated the summary risk ratios (RRs) or effect size (ES) with its corresponding 95% confidence interval (95%CI) to assess the outcomes. Results: We included 8 RCTs enrolling 528 severe CAP patients. Adjunctive corticosteroids significantly reduced all-cause mortality (RR = 0.46, 95%CI: 0.28 to 0.77, p = 0.003), risk of adult respiratory distress syndrome (ARDS) (RR = 0.23, 95%CI: 0.07 to 0.80, p = 0.02) and need for mechanical ventilation (RR = 0.50, 95%CI: 0.27 to 0.92, p = 0.026). Adjunctive corticosteroids did not increase frequency of hyperglycemia requiring treatment (RR = 1.03, 95%CI: 0.61 to 1.72, p = 0.91) or gastrointestinal hemorrhage (RR = 0.66, 95%CI: 0.19 to 2.31, p = 0.52). In subgroup analysis by duration of corticosteroids, we found that prolonged corticosteroids therapy significantly reduced all-cause mortality (RR = 0.41, 95%CI: 0.20 to 0.83, p = 0.01) and length of hospital stay (−4.76 days, 95% CI:-8.13 to -1.40, p = 0.006). Conclusions: Results from this meta-analysis suggested that adjunctive corticosteroids therapy was safe and beneficial for severe CAP. In addition, prolonged corticosteroids therapy was more effective. These results should be confirmed by adequately powered studies in the future.

Suggested Citation

  • Jirui Bi & Jin Yang & Ying Wang & Cijiang Yao & Jing Mei & Ying Liu & Jiyu Cao & Youjin Lu, 2016. "Efficacy and Safety of Adjunctive Corticosteroids Therapy for Severe Community-Acquired Pneumonia in Adults: An Updated Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-15, November.
    • Handle: RePEc:plo:pone00:0165942
    DOI: 10.1371/journal.pone.0165942
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    References listed on IDEAS

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    1. Wei Nie & Yi Zhang & Jinwei Cheng & Qingyu Xiu, 2012. "Corticosteroids in the Treatment of Community-Acquired Pneumonia in Adults: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-7, October.
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