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Sci Rep. 2015 Sep 16;5:14061. doi: 10.1038/srep14061.

Adjunctive Systemic Corticosteroids for Hospitalized Community-Acquired Pneumonia: Systematic Review and Meta-Analysis 2015 Update.

Author information

1
Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
2
Department of Pulmonology, Tohoku Rosai Hospital, Sendai, Japan.
3
Department of Infectious Diseases, Respiratory and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
4
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
5
Department of Respiratory Medicine, Japanese Red Cross Sendai Hospital, Sendai Japan.
6
Department of Internal Medicine I, Kawasaki Medical School, Okayama, Japan.
7
National Hospital Organization Okinawa National Hospital, Okinawa, Japan.
8
Department of Respiratory Medicine, Saka General Hospital, Miyagi, Japan.
9
Department of Hemodialysis and Surgery, Chemotheraphy Research Institute, International University of Health and Welfare, Ichikawa, Japan.
10
Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Abstract

Previous randomized controlled trials (RCTs) and meta-analyses evaluated the efficacy and safety of adjunctive corticosteroids for community-acquired pneumonia (CAP). However, the results from them had large discrepancies. The eligibility criteria for the current meta-analysis were original RCTs written in English as a full article that evaluated adjunctive systemic corticosteroids adding on antibiotic therapy targeting typical and/or atypical pathogen for treating hospitalized human CAP cases. Four investigators independently searched for eligible articles through PubMed, Embase, and Cochrane databases. Random model was used. The heterogeneity among original studies and subgroups was evaluated with the I(2) statistics. Of 54 articles that met the preliminary criteria, we found 10 eligible RCTs comprising 1780 cases. Our analyses revealed following pooled values by corticosteroids. OR for all-cause death: 0.80 (95% confidence interval (95% CI) 0.53-1.21) from all studies; 0.41 (95% CI 0.19-0.90) from severe-case subgroup; 0.21 (95% CI 0.0-0.74) from intensive care unit (ICU) subgroup. Length of ICU stay: -1.30 days (95% CI (-3.04)-0.44). Length of hospital stay: -0.98 days (95% CI (-1.26)-(-0.71)). Length to clinical stability: -1.16 days (95% CI (-1.73)-(-0.58)). Serious complications do not seem to largely increase by steroids. In conclusion, adjunctive systemic corticosteroids for hospitalized patients with CAP seems preferred strategies.

PMID:
26374694
PMCID:
PMC4571641
DOI:
10.1038/srep14061
[Indexed for MEDLINE]
Free PMC Article

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