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Purpose <p>International clinical practice guidelines addressing corticosteroid treatment for patients hospitalised with non-viral community-acquired pneumonia (CAP) are inconsistent.</p> Methods <p>We conducted a systematic review of randomized controlled trials (RCTs) evaluating the use of corticosteroids in hospitalised adult patients with suspected or probable CAP. We performed random effects pairwise, Bayesian, and dose–response meta-analyses using the restricted maximum likelihood (REML) heterogeneity estimator. We assessed certainty of evidence using GRADE methodology.</p> Results <p>We identified 30 eligible RCTs, including a total of 7519 patients. The prednisone-equivalent doses ranged between 29&#xa0;mg/day and 100&#xa0;mg/day. Corticosteroids probably reduced short-term (28–30&#xa0;days) mortality (RR 0.82 [95% CI 0.74–0.91]; moderate certainty) while the reduction in longer term (60–90&#xa0;day) mortality is less certain (RR 0.89 [95% CI 0.76–1.03]; low certainty). Corticosteroids reduced the need for invasive mechanical ventilation (IMV) (RR 0.63 [95% CI 0.48–0.82]; high certainty) and may reduce duration of ICU stay (MD 1.53&#xa0;days fewer [95% CI 0.31–2.75&#xa0;days fewer]; low certainty), and hospital stay (MD 2.30&#xa0;days fewer [95% CI 0.81–3.81&#xa0;days fewer]; low certainty). Corticosteroids probably increased hyperglycaemia requiring intervention (RR 1.32 [95% CI 1.12–1.56]; moderate certainty) but probably have no effect on secondary infections (RR 0.97 [95% CI 0.85–1.11]; moderate certainty).</p> Conclusion <p>Corticosteroids probably reduced short-term mortality and reduce the need for invasive mechanical ventilation in hospitalised patients with CAP.</p> PROSPERO registration number <p>CRD42024521536.</p>

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Corticosteroids for adult patients hospitalised with non-viral community-acquired pneumonia: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年5月5日

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  • Tyler Pitre,
  • Ellen Pauley,
  • Dipayan Chaudhuri,
  • Rohit Saha,
  • Kristina E. Rudd,
  • Jesús Villar,
  • Lindsay R. Berry,
  • Elizabeth Lorenzi,
  • Thomas Hills,
  • Alistair Nichol,
  • David A. Harrison,
  • Simon Finfer,
  • Jeremy Cohen,
  • John Myburgh,
  • Naomi Hammond,
  • Domingo Martínez,
  • Cristina Fernández,
  • David Antcliffe,
  • Anthony Gordon,
  • André Scherag,
  • Holger Bogatsch,
  • Frank M. Brunkhorst,
  • Balasubramanian Venkatesh,
  • Djillali Annane,
  • Danny McAuley,
  • Derek C. Angus,
  • Bram Rochwerg,
  • Manu Shankar-Hari

摘要

Purpose

International clinical practice guidelines addressing corticosteroid treatment for patients hospitalised with non-viral community-acquired pneumonia (CAP) are inconsistent.

Methods

We conducted a systematic review of randomized controlled trials (RCTs) evaluating the use of corticosteroids in hospitalised adult patients with suspected or probable CAP. We performed random effects pairwise, Bayesian, and dose–response meta-analyses using the restricted maximum likelihood (REML) heterogeneity estimator. We assessed certainty of evidence using GRADE methodology.

Results

We identified 30 eligible RCTs, including a total of 7519 patients. The prednisone-equivalent doses ranged between 29 mg/day and 100 mg/day. Corticosteroids probably reduced short-term (28–30 days) mortality (RR 0.82 [95% CI 0.74–0.91]; moderate certainty) while the reduction in longer term (60–90 day) mortality is less certain (RR 0.89 [95% CI 0.76–1.03]; low certainty). Corticosteroids reduced the need for invasive mechanical ventilation (IMV) (RR 0.63 [95% CI 0.48–0.82]; high certainty) and may reduce duration of ICU stay (MD 1.53 days fewer [95% CI 0.31–2.75 days fewer]; low certainty), and hospital stay (MD 2.30 days fewer [95% CI 0.81–3.81 days fewer]; low certainty). Corticosteroids probably increased hyperglycaemia requiring intervention (RR 1.32 [95% CI 1.12–1.56]; moderate certainty) but probably have no effect on secondary infections (RR 0.97 [95% CI 0.85–1.11]; moderate certainty).

Conclusion

Corticosteroids probably reduced short-term mortality and reduce the need for invasive mechanical ventilation in hospitalised patients with CAP.

PROSPERO registration number

CRD42024521536.