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Clin Infect Dis. 2018 Jan 18;66(3):346-354. doi: 10.1093/cid/cix801.

Corticosteroids in Patients Hospitalized With Community-Acquired Pneumonia: Systematic Review and Individual Patient Data Metaanalysis.

Author information

1
Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland.
2
Department of Clinical Epidemiology & Biostatistics, McMaster University, Ontario, Canada.
3
Department of Internal Medicine, St. Antonius Hospital, Nieuwegein.
4
Department of Pulmonology, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands.
5
Department of Pulmonology, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Ciber de Enfermedades Respiratorias, University of Barcelona.
6
Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, Spain.
7
Department of Pneumology and Respiratory Intensive Care Unit, University Hospital of Cattinara, Trieste, Italy.
8
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Memphis Veterans Affairs Medical Center, Tennessee.
9
Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel.
10
Medical University Clinic, Kantonsspital Aarau, Switzerland.
11
Department of Medicine, University of Toronto, Ontario, Canada.
12
Department of Pulmonary Diseases, Noordwest Hospital Alkmaar, The Netherlands.

Abstract

Background:

Our aim was to evaluate the benefits and harms of adjunctive corticosteroids in adults hospitalized with community-acquired pneumonia (CAP) using individual patient data from randomized, placebo-controlled trials and to explore subgroup differences.

Methods:

We systematically searched Medline, Embase, Cochrane Central, and trial registers (all through July 2017). Data from 1506 individual patients in 6 trials were analyzed using uniform outcome definitions. We investigated prespecified effect modifiers using multivariable hierarchical regression, adjusting for pneumonia severity, age, and clustering effects.

Results:

Within 30 days of randomization, 37 of 748 patients (5.0%) assigned to corticosteroids and 45 of 758 patients (5.9%) assigned to placebo died (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], .46 to 1.21; P &#x003D; .24). Time to clinical stability and length of hospital stay were reduced by approximately 1 day with corticosteroids (-1.03 days; 95% CI, -1.62 to -.43; P &#x003D; .001 and -1.15 days; 95% CI, -1.75 to -.55; P < .001, respectively). More patients with corticosteroids had hyperglycemia (160 [22.1%] vs 88 [12.0%]; aOR, 2.15; 95% CI, 1.60 to 2.90; P < .001) and CAP-related rehospitalization (33 [5.0%] vs 18 [2.7%]; aOR, 1.85; 95% CI, 1.03 to 3.32; P &#x003D; .04). We did not find significant effect modification by CAP severity or degree of inflammation.

Conclusions:

Adjunct corticosteroids for patients hospitalized with CAP reduce time to clinical stability and length of hospital stay by approximately 1 day without a significant effect on overall mortality but with an increased risk for CAP-related rehospitalization and hyperglycemia.

KEYWORDS:

community-acquired pneumonia; corticosteroids; individual patient data metaanalysis; randomized clinical trials

PMID:
29020323
DOI:
10.1093/cid/cix801
[Indexed for MEDLINE]

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