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Original Research: Chest Infections |

Efficacy and Safety of Corticosteroids for Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis

You-Dong Wan, MD; Tong-Wen Sun, MD, PhD; Zi-Qi Liu, MD; Shu-Guang Zhang, MD; Le-Xin Wang, MD, PhD; Quan-Cheng Kan, MD, PhD
Author and Funding Information

FUNDING SUPPORT: This study was supported by the National Natural Science Foundation of China (Grant No. 81370364) and an Innovative investigators project grant from the Health Bureau of Henan Province, Henan Province of Medical Scientific Province & Ministry Research Project (201301005).

CORRESPONDENCE TO: Tong-Wen Sun, MD, PhD, Department of Integrated Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou 450052, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(1):209-219. doi:10.1378/chest.15-1733
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Background  Corticosteroids are an option in the treatment of community-acquired pneumonia (CAP). However, the benefits and adverse effects of corticosteroids, especially in severe CAP, have not been well assessed.

Methods  PubMed, Embase, and Cochrane library databases from inception to May 2015 were searched. Randomized controlled trials (RCTs) and cohort studies that evaluated use of corticosteroids in adult patients with CAP were included. The quality of outcomes was evaluated using Grading of Recommendations Assessment, Development and Evaluation methodology. The Mantel-Haenszel method with random-effects modeling was used to calculate pooled relative risks (RRs) and 95% CIs.

Results  Nine eligible RCTs (1,667 patients) and six cohort studies (4,095 patients) were identified. The mean corticosteroid dose and treatment duration were 30 mg/day methylprednisolone for 7 days. Corticosteroids did not have a statistically significant effect on mortality (RR, 0.72; 95% CI, 0.43-1.21; evidence rank, low) in patients with CAP and patients with severe CAP (RCTs: RR, 0.72; 95% CI, 0.43-1.21; evidence rank, low; cohort studies: RR, 1.00; 95% CI, 0.86-1.17 ). Corticosteroids treatment was associated with a decreased risk of ARDS (RR, 0.21; 95% CI, 0.08-0.59) and may reduce lengths of hospital and ICU stay, duration of IV antibiotic treatment, and time to clinical stability. Corticosteroids were not associated with increased rates of adverse events.

Conclusions  Short-term treatment with corticosteroids is safe and may reduce the risk of ARDS, shortening the length of the disease in patients with CAP.

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