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Corticosteroids for CAP, influenza and COVID-19: when, how and benefits or harm?

Ignacio Martin-Loeches, Antoni Torres
European Respiratory Review 2021 30: 200346; DOI: 10.1183/16000617.0346-2020
Ignacio Martin-Loeches
1Multidisciplinary Intensive Care Research Organization (MICRO), Dept of Intensive Care Medicine, St James's University Hospital, Dublin, Ireland
2Trinity Centre for Health Sciences, Dublin, Ireland
3Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
4Universitat de Barcelona, Barcelona, Spain
5CIBERes, Barcelona, Spain
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  • For correspondence: drmartinloeches@gmail.com
Antoni Torres
3Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
4Universitat de Barcelona, Barcelona, Spain
5CIBERes, Barcelona, Spain
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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 patientPatientsRCTsFindings
    Siempos, 2008 [16]CAP with any severity (only studies for severe CAP were found)1894Limited data suggest that corticosteroid treatment lowers mortality and shortens length of hospital stay for severe CAP
    Salluh, 2010 [13]Severe CAP4153Do not recommend corticosteroids for severe CAP
    Chen, 2011 [17]Any type of pneumonia including nosocomial and child pneumonia4376Corticosteroids are generally beneficial for pneumonia
    Evidence to make recommendation is lacking
    Nie, 2012 [18]CAP with any severity10019Corticosteroids 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 CAP2644Limited evidence suggests that corticosteroid treatment lowers mortality from severe CAP
    Shafiq, 2013 [14]CAP requiring admission11198Corticosteroids shorten length of hospital stay
    Corticosteroids do not lower mortality
    Horita, 2015 [19]CAP requiring admission178010Corticosteroids 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 effective
    Stern, 2017 [20]Any type of pneumonia including nosocomial and child pneumonia226417Corticosteroids 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 hyperglycaemia
    Briel, 2018 [21]CAP in Europe between 2000 and 20141506 (individual data analysis)6Corticosteroid 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 hyperglycaemia
    Jiang, 2019 [22]Severe CAP66510Corticosteroids 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 regimen

    Data 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)

      CAPCOVID-19
      SeverityIDSA/ATS severe CAP [11]Severe acute respiratory failure#
      TimingFirst 24 hFirst 24 h
      Type of steroids and dosagePrednisone (50 mg daily)
      Methylprednisolone (40–80 mg daily)
      Dexamethasone (5 mg daily)
      Dexamethasone (6 mg daily)
      Hydrocortisone (200 mg daily)
      Duration5–8 days7 days
      OutcomeDecrease treatment failure and mortalityDecrease mortality
      HarmsIncreased readmission in one studyCAPA?

      IDSA: Infectious Diseases Society of America; ATS: American Thoracic Society; CAPA: COVID-19-associated pulmonary aspergillosis. #: as defined in the RECOVERY trial [58].

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      Corticosteroids for CAP, influenza and COVID-19: when, how and benefits or harm?
      Ignacio Martin-Loeches, Antoni Torres
      European Respiratory Review Mar 2021, 30 (159) 200346; DOI: 10.1183/16000617.0346-2020

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      Corticosteroids for CAP, influenza and COVID-19: when, how and benefits or harm?
      Ignacio Martin-Loeches, Antoni Torres
      European Respiratory Review Mar 2021, 30 (159) 200346; DOI: 10.1183/16000617.0346-2020
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      • Article
        • Abstract
        • Abstract
        • Introduction
        • Mechanism of action
        • Corticosteroids in CAP
        • Role of viruses in CAP
        • Corticosteroids in influenza
        • Corticosteroids in coronavirus disease 2019
        • Corticosteroids and nosocomial infections
        • Conclusions
        • Footnotes
        • References
      • Figures & Data
      • Info & Metrics
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