Effects of systemic steroids on patients with community-acquired pneumonia: Observational study from a tertiary care hospital of a developing country

Background: Steroid administration has been used as an adjunctive therapy in severe community-acquired pneumonia (SCAP), but there is limited evidence from developing countries to support their use. This study aimed to determine the effects of systemic steroids in patients with community-acquired pneumonia (CAP) in a tertiary care hospital in Pakistan.

Methods: A retrospective observational study was performed among patients admitted with a primary diagnosis of CAP at the Aga Khan University Hospital in Karachi, Pakistan. We conducted binary logistic and negative binomial regression analyses to observe the effects of intravenous (IV) steroids on in-hospital mortality, length of hospital stay (LOS), and time to clinical stability (TCS).

Results: A total of 1100 cases were reviewed, out of which 508 were included in our analysis; 173 (34.0%) patients received IV steroids. These patients had a higher proportion of comorbidities such as asthma (p = 0.002) and chronic obstructive pulmonary disease (COPD; p < 0.001), bilateral lung opacities/multilobar involvement (p < 0.001), and higher CURB-65 scores (p < 0.001) than the non-steroid group. Overall mortality was 10.8%. The adjusted estimates did not demonstrate any effect of systemic steroids on mortality (AOR: 0.85, 95% CI: 0.39-1.88). In fact, patients receiving IV steroid treatment showed a significantly longer duration of hospitalization (IRR: 1.51, 95% CI: 1.37-1.66) and had a longer TCS (IRR: 1.50, 95% CI: 1.13-1.33).

Conclusion: Our study does not demonstrate any mortality benefit with steroids in CAP. On the other hand, the patients showed a longer hospital stay and longer time to stability.