The aim of this review is to examine existing literature data on steroid use in severe pneumonia. CAP = community-acquired pneumonia.Subgroup analysis for the effect of steroids on mortality.Effect of steroids on the length of ICU stay in patients with severe CAP. Quality of the studies was moderate (see Supporting Information, Appendix I, in the online version of this article). Community‐acquired pneumonia (CAP) is the most common lower respiratory tract infection in adults and a leading cause of infection‐related deaths in the United States.Empirical evidence suggests that host inflammatory response contributes significantly to lung injury in pneumonia.In their meta‐analysis, Chen et al.

Controlled vocabulary, supplemented with keywords, was used to search for the topic: steroid therapy for community‐acquired pneumonia. Kappa statistic was calculated to assess the reviewers' level of agreement.We perused full texts of all articles whose abstracts met selection criteria, performing an appraisal of their quality using the Cochrane risk‐of‐bias tool.We estimated RR and weighted mean differences along with the respective 95% confidence intervals by pooling data using a random effects model.The original investigators were not contacted for purposes of obtaining raw data.Eight RCTs, comprising 1119 subjects, were eventually chosen.The mean ICU length of stay was 12.7 days for the steroid group and 12.3 days for the control group. 2019 Dec 5;23(1):394. doi: 10.1186/s13054-019-2680-6.Antimicrob Agents Chemother. However, steroid use was associated with lower incidence of delayed shock (ie, shock occurring after enrollment (RR: 0.12 [95% CI: 0.03 to 0.41]) and lower incidence of persistent chest x‐ray abnormalities at 1 week (RR: 0.13 [95% CI: 0.06 to 0.27]).Using the GRADE framework, the overall quality of evidence (confidence in the estimates) was judged to be moderate with the following main limitations: 1) methodological limitations among included studies (prognostic imbalance), 2) imprecision (small number of events and wide confidence intervals), and 3) inconsistency in the outcome ICU length of stay (as reflected by the In this meta‐analysis of 8 RCTs, we found no significant association between steroid therapy and our primary outcome of interest (hospital mortality). Author information: (1)Department of Respiratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University. Clipboard, Search History, and several other advanced features are temporarily unavailable. Print 2020 Jan 27. However, it is not inconceivable that steroid use led to a quicker decline in cytokine levels resulting in an earlier resolution of fever and hence earlier discharge without a faster cure per se. An experienced institutional librarian assisted with the design and conduct of our literature search.

Standardizing the intervention (including dose and duration of steroid therapy and time to first antibiotic dose) would be essential. However, only 2 studies reported this outcome.The 2 studies that were published before 2000 (McHardy and Schonell,In spite of our relatively stringent selection criteria and a number of subgroup and sensitivity analyses, the overall quality of evidence was only moderate (Table In conclusion, although evidence suggests that adjunctive steroid therapy is associated with reduced hospital length of stay, the data are not strong enough to recommend routine use of steroids among all adults hospitalized with CAP. published a systematic review and meta-analysis on the efficacy and safety of corticosteroids for community-acquired pneumonia [CAP].

Although adverse effects of steroid therapy were not consistently reported, most of the RCTs reported that hyperglycemia was either no more common in the steroid group or did not require additional treatment.Previous meta‐analyses have also concluded that adding corticosteroids to conventional therapy does not impact mortality among adults hospitalized with CAP.Our study is the first to demonstrate decreased length of hospital stay in this patient population.

BACKGROUNDCommunity‐acquired pneumonia (CAP) is a leading cause of morbidity and mortality among adults. However, the results of clinical studies of the effect of corticosteroids remain controversial.

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