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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
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FINANCIAL/NONFINACIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

CORRESPONDENCE TO: Tong-Wen Sun, MD, PhD, Department of Integrated Intensive Care Unit, First Affiliated Hospital, Zhengzhou University, 1 Jianshe East Road, Zhengzhou, Henan 450000, China


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


Chest. 2016;149(4):1105. doi:10.1016/j.chest.2015.11.019
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We thank Dr Horita and colleagues for their interest in our article in CHEST. We agree with their views that adjunctive corticosteroid treatment may be indicated for severe community-acquired pneumonia (CAP) because of its beneficial effects on the length of hospital stay, the length of time to clinical stability, and the risk of acute respiratory distress syndrome. Allowing for the risk of infection escalation due to corticosteroid use before effective antimicrobial drugs are administered, and the negative results of early meta-analyses, current guidelines do not recommend the use of corticosteroids in CAP., More recently, with the publication of large-size randomized trials and meta-analyses, some benefits of corticosteroids have been found in the management of CAP, especially in patients with severe CAP.

Although inconsistent results on mortality in severe CAP are found between the studies by Horita et al and our study, we believe that many factors may have contributed to the differences between these studies. Most published studies concerning corticosteroid use for severe CAP have been small, which may have had a negative impact on the accuracy of conclusions (usually overestimating the true results). Our trial sequential analysis indicated that the cumulative evidence on corticosteroids for severe CAP is still unreliable and inconclusive. We believe that additional randomized and placebo-controlled trials on corticosteroids and severe CAP are needed to help form therapeutic guidelines and clinical decision-making.

References

Wan Y.D. .Sun T.W. .Liu Z.Q. .Zhang S.G. .Wang L.X. .Kan Q.C. . Efficacy and safety of corticosteroids for community-acquired pneumonia: a systematic review and meta-analysis. Chest. 2016;149:209-219 [PubMed]journal. [CrossRef] [PubMed]
 
Mandell L.A. .Wunderink R.G. .Anzueto A. .et al Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-S72 [PubMed]journal. [CrossRef] [PubMed]
 
Woodhead M. .Blasi F. .Ewig S. .et al Guidelines for the management of adult lower respiratory tract infections—full version. Clin Microbiol Infect. 2011;17:E1-E59 [PubMed]journal
 
Horita N. .Otsuka T. .Haranaga S. .et al Adjunctive systemic corticosteroids for hospitalized community-acquired pneumonia: systematic review and meta-analysis 2015 update. Sci Rep. 2015;16:14061- [PubMed]journal
 
Sterne J.A. .Gavaghan D. .Egger M. . Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000;53:1119-1129 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Wan Y.D. .Sun T.W. .Liu Z.Q. .Zhang S.G. .Wang L.X. .Kan Q.C. . Efficacy and safety of corticosteroids for community-acquired pneumonia: a systematic review and meta-analysis. Chest. 2016;149:209-219 [PubMed]journal. [CrossRef] [PubMed]
 
Mandell L.A. .Wunderink R.G. .Anzueto A. .et al Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-S72 [PubMed]journal. [CrossRef] [PubMed]
 
Woodhead M. .Blasi F. .Ewig S. .et al Guidelines for the management of adult lower respiratory tract infections—full version. Clin Microbiol Infect. 2011;17:E1-E59 [PubMed]journal
 
Horita N. .Otsuka T. .Haranaga S. .et al Adjunctive systemic corticosteroids for hospitalized community-acquired pneumonia: systematic review and meta-analysis 2015 update. Sci Rep. 2015;16:14061- [PubMed]journal
 
Sterne J.A. .Gavaghan D. .Egger M. . Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000;53:1119-1129 [PubMed]journal. [CrossRef] [PubMed]
 
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