Tables
- TABLE 1
Systematic review and meta-analysis for the use of corticosteroids in patients with community-acquired pneumonia (CAP)
Author, year [reference] Type of patient Patients RCTs Findings Siempos, 2008 [16] CAP with any severity (only studies for severe CAP were found) 189 4 Limited data suggest that corticosteroid treatment lowers mortality and shortens length of hospital stay for severe CAP Salluh, 2010 [13] Severe CAP 415 3 Do not recommend corticosteroids for severe CAP Chen, 2011 [17] Any type of pneumonia including nosocomial and child pneumonia 437 6 Corticosteroids are generally beneficial for pneumonia
Evidence to make recommendation is lackingNie, 2012 [18] CAP with any severity 1001 9 Corticosteroids are not recommended for CAP in general; however, it is possible that corticosteroids lower mortality from severe CAP and that corticosteroid treatment >6 days may be more beneficial than ≤5 days Cheng, 2014 [15] Severe CAP 264 4 Limited evidence suggests that corticosteroid treatment lowers mortality from severe CAP Shafiq, 2013 [14] CAP requiring admission 1119 8 Corticosteroids shorten length of hospital stay
Corticosteroids do not lower mortalityHorita, 2015 [19] CAP requiring admission 1780 10 Corticosteroids shorten length of hospital stay for CAP
Corticosteroids shorten length to clinical stability for CAP
Corticosteroids lower mortality for CAP in ICU
Corticosteroids ≥6 days is not more effectiveStern, 2017 [20] Any type of pneumonia including nosocomial and child pneumonia 2264 17 Corticosteroids reduced mortality and morbidity in adults with severe CAP
Corticosteroids reduced morbidity, but not mortality, for adults and children with nonsevere CAP
Corticosteroids were associated with more adverse events, especially hyperglycaemiaBriel, 2018 [21] CAP in Europe between 2000 and 2014 1506 (individual data analysis) 6 Corticosteroid treatment shortens time to clinical stability and length of hospital stay
Corticosteroid treatment does not lower mortality
Corticosteroids increased risk for CAP-related rehospitalisation and hyperglycaemiaJiang, 2019 [22] Severe CAP 665 10 Corticosteroids decreased all-cause mortality, incidence of septic shock and requirement for mechanical ventilation
Low dose (≤86 mg·day−1), prolonged use (>5 days) of corticosteroids in dosage modus of a maintenance dose after a bolus can be recommended as preferred regimenData are presented as n. RCT: randomised controlled trial; ICU: intensive care unit.
- TABLE 2
Corticosteroids in community-acquired pneumonia (CAP) versus coronavirus disease-2019 (COVID-19)
CAP COVID-19 Severity IDSA/ATS severe CAP [11] Severe acute respiratory failure# Timing First 24 h First 24 h Type of steroids and dosage Prednisone (50 mg daily)
Methylprednisolone (40–80 mg daily)
Dexamethasone (5 mg daily)Dexamethasone (6 mg daily)
Hydrocortisone (200 mg daily)Duration 5–8 days 7 days Outcome Decrease treatment failure and mortality Decrease mortality Harms Increased readmission in one study CAPA? IDSA: Infectious Diseases Society of America; ATS: American Thoracic Society; CAPA: COVID-19-associated pulmonary aspergillosis. #: as defined in the RECOVERY trial [58].