Adjuvant steroid therapy in community-acquired pneumonia: A systematic review and meta-analysis

BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality among adults. Although steroids appear to be beneficial in animal models of CAP, clinical trial data in humans are either equivocal or conflicting. PURPOSE: Our purpose was to perform a systematic review and meta-analysis of studies examining the impact of steroid therapy on clinical outcomes among adults admitted with CAP. DATA SOURCES AND STUDY SELECTION: We identified randomized controlled trials (RCTs) through a systematic search of published literature up to July 2011. DATA EXTRACTION: We estimated relative risks (RR) and weighted mean differences, pooled from each study using a random effects model. DATA SYNTHESIS: Eight RCTs, comprising 1119 patients, met our selection criteria. Overall quality of the studies was moderate. Adjunctive steroid therapy had no effect on hospital mortality or length of stay in the intensive care unit, but reduced the overall length of hospital stay (RR: -1.21 days [95% confidence interval (CI): -2.12 to -0.29]). Less robust data also demonstrated reduced incidence of delayed shock (RR: 0.12 [95% CI: 0.03 to 0.41]) and reduced persistence of chest x-ray abnormalities (RR: 0.13 [95% CI: 0.06 to 0.27]). A priori subgroup and sensitivity analyses did not alter these findings. CONCLUSIONS: Moderate-quality evidence suggests that adjunctive steroid therapy for adults hospitalized with CAP reduced the length of hospital stay but did not alter mortality. Journal of Hospital Medicine 2013;8:68-75.