1. 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.

Briel M(1)(2), Spoorenberg SMC(3), Snijders D(4), Torres A(5), Fernandez-Serrano 
S(6), Meduri GU(7)(8), Gabarrús A(5), Blum CA(9)(10), Confalonieri M(7), Kasenda 
B(1), Siemieniuk RAC(2)(11), Boersma W(12), Bos WJW(3), Christ-Crain M(9);
Ovidius Study Group; Capisce Study Group; STEP Study Group.

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.

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 =
.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.

© The Author 2017. Published by Oxford University Press for the Infectious
Diseases Society of America. All rights reserved. For permissions, e-mail:
journals.permissions@oup.com.

DOI: 10.1093/cid/cix801 
PMID: 29020323