Impact of different corticosteroids on severe community-acquired pneumonia: a systematic review and meta-analysis

Authors

Xin Ya See, Rochester Regional HealthFollow
Tsu Hsien Wang, Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City, Taiwan.
Yu-Cheng Chang, Department of Medicine, Danbury Hospital, Danbury, Connecticut, USA.
Juien Lo, Department of Medicine, University of California San Diego, San Diego, California, USA.
Weitao Liu, Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA.
Cheryn Yu Choo, Department of Internal Medicine, Singapore Health Services, Singapore.
Yu-Che Lee, Division of Pulmonary, Critical Care and Sleep Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Kevin Sheng Ma, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Cho-Hsien Chiang, Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yuan Ping Hsia, Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City, Taiwan
Cho-Hung Chiang, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Cho-Han Chiang, Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA.

Department

Internal Medicine

Document Type

Article

Publication Title

BMJ Open Respiratory Research

Abstract

Objectives: Randomised controlled trials (RCTs) have demonstrated conflicting results regarding the effects of corticosteroids on the treatment of severe community-acquired pneumonia (CAP). We aimed to investigate the efficacy and safety of different corticosteroids on patients who were hospitalised for severe CAP.

Methods: We performed a systematic search through PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to May 2023. The primary outcome was all-cause mortality. Data analysis was performed using a random-effects model.

Results: A total of 10 RCTs comprising 1962 patients were included. Corticosteroids were associated with a lower rate of all-cause mortality (risk ratio (RR), 0.70 (95% CI 0.54 to 0.90); I²=0.00%). When stratified into different corticosteroid types, hydrocortisone was associated with an approximately 50% lower mortality risk (RR, 0.48 (95% CI 0.32 to 0.72); I²=0.00%). However, dexamethasone, methylprednisolone or prednisolone were not associated with an improvement in mortality. Furthermore, hydrocortisone was associated with a reduction in the rate of mechanical ventilation, acute respiratory distress syndrome, shock and duration of intensive care unit stay. These trends were not observed for dexamethasone, methylprednisolone or prednisolone. Corticosteroids were not associated with an increased risk of adverse events including gastrointestinal bleeding, secondary infection or hyperglycaemia.

Conclusions: The use of hydrocortisone, but not other types of corticosteroids, was associated with a reduction in mortality and improvement in pneumonia outcomes among patients hospitalised with severe CAP.PROSPERO registration numberCRD42023431360.

First Page

e002141

DOI

10.1136/bmjresp-2023-002141

Volume

11

Issue

1

Publication Date

1-22-2024

Medical Subject Headings

Humans; Hydrocortisone; Adrenal Cortex Hormones; Methylprednisolone; Community-Acquired Infections; Pneumonia; Dexamethasone

PubMed ID

38262670

Recommended Citation

See, X. Y., Wang, T. H., Chang, Y., Lo, J., Liu, W., Choo, C. Y., Lee, Y., Ma, K. S., Chiang, C., Hsia, Y. P., Chiang, C., & Chiang, C. (2024). Impact of different corticosteroids on severe community-acquired pneumonia: a systematic review and meta-analysis. BMJ Open Respiratory Research, 11 (1), e002141. https://doi.org/10.1136/bmjresp-2023-002141