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.