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Meta-Analysis
. 2017 Dec 13;12(12):CD007720.
doi: 10.1002/14651858.CD007720.pub3.

Corticosteroids for pneumonia

Anat Stern  1 , Keren Skalsky, Tomer Avni, Elena Carrara, Leonard Leibovici, Mical Paul
Affiliations
Meta-Analysis

Corticosteroids for pneumonia

Anat Stern et al. Cochrane Database Syst Rev. .

Abstract

Background: Pneumonia is a common and potentially serious illness. Corticosteroids have been suggested for the treatment of different types of infection, however their role in the treatment of pneumonia remains unclear. This is an update of a review published in 2011.

Objectives: To assess the efficacy and safety of corticosteroids in the treatment of pneumonia.

Search methods: We searched the Cochrane Acute Respiratory Infections Group's Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS on 3 March 2017, together with relevant conference proceedings and references of identified trials. We also searched three trials registers for ongoing and unpublished trials.

Selection criteria: We included randomised controlled trials (RCTs) that assessed systemic corticosteroid therapy, given as adjunct to antibiotic treatment, versus placebo or no corticosteroids for adults and children with pneumonia.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. We estimated risk ratios (RR) with 95% confidence intervals (CI) and pooled data using the Mantel-Haenszel fixed-effect model when possible.

Main results: We included 17 RCTs comprising a total of 2264 participants; 13 RCTs included 1954 adult participants, and four RCTs included 310 children. This update included 12 new studies, excluded one previously included study, and excluded five new trials. One trial awaits classification.All trials limited inclusion to inpatients with community-acquired pneumonia (CAP), with or without healthcare-associated pneumonia (HCAP). We assessed the risk of selection bias and attrition bias as low or unclear overall. We assessed performance bias risk as low for nine trials, unclear for one trial, and high for seven trials. We assessed reporting bias risk as low for three trials and high for the remaining 14 trials.Corticosteroids significantly reduced mortality in adults with severe pneumonia (RR 0.58, 95% CI 0.40 to 0.84; moderate-quality evidence), but not in adults with non-severe pneumonia (RR 0.95, 95% CI 0.45 to 2.00). Early clinical failure rates (defined as death from any cause, radiographic progression, or clinical instability at day 5 to 8) were significantly reduced with corticosteroids in people with severe and non-severe pneumonia (RR 0.32, 95% CI 0.15 to 0.7; and RR 0.68, 95% CI 0.56 to 0.83, respectively; high-quality evidence). Corstocosteroids reduced time to clinical cure, length of hospital and intensive care unit stays, development of respiratory failure or shock not present at pneumonia onset, and rates of pneumonia complications.Among children with bacterial pneumonia, corticosteroids reduced early clinical failure rates (defined as for adults, RR 0.41, 95% CI 0.24 to 0.70; high-quality evidence) based on two small, clinically heterogeneous trials, and reduced time to clinical cure.Hyperglycaemia was significantly more common in adults treated with corticosteroids (RR 1.72, 95% CI 1.38 to 2.14). There were no significant differences between corticosteroid-treated people and controls for other adverse events or secondary infections (RR 1.19, 95% CI 0.73 to 1.93).

Authors' conclusions: Corticosteroid therapy reduced mortality and morbidity in adults with severe CAP; the number needed to treat for an additional beneficial outcome was 18 patients (95% CI 12 to 49) to prevent one death. Corticosteroid therapy reduced morbidity, but not mortality, for adults and children with non-severe CAP. Corticosteroid therapy was associated with more adverse events, especially hyperglycaemia, but the harms did not seem to outweigh the benefits.

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Conflict of interest statement

  1. Anat Stern ‐ None known.

  2. Keren Skalsky ‐ None known.

  3. Tomer Avni ‐ None known.

  4. Elena Carrara ‐ None known.

  5. Leonard Leibovici ‐ None known.

  6. Mical Paul ‐ None known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 Corticosteroids versus no treatment or placebo, outcome: 1.1 Mortality ‐ adults.
5
5
Meta‐regression of the log risk ratios for the effect of steroids on mortality against the mortality rate (%) in the control group.
6
6
Meta‐regression of the log risk ratios for the effect of steroids on mortality against the mean age in the study population.
1.1
1.1. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 1 Mortality ‐ adults.
1.2
1.2. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 2 Mortality ‐ adults, severe pneumonia, by allocation concealment.
1.3
1.3. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 3 Mortality ‐ adults, non‐severe pneumonia, by allocation concealment.
1.4
1.4. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 4 Mortality ‐ children.
1.5
1.5. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 5 Early clinical failure ‐ adults.
1.6
1.6. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 6 Early clinical failure ‐ children.
1.7
1.7. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 7 Early clinical failure ‐ adults + children by allocation concealment.
1.8
1.8. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 8 Time to clinical cure ‐ adults.
1.9
1.9. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 9 Time to clinical cure ‐ children.
1.10
1.10. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 10 Need for mechanical ventilation ‐ adults.
1.11
1.11. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 11 Development of shock ‐ adults.
1.12
1.12. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 12 Need for ICU transfer ‐ adults.
1.13
1.13. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 13 Length of hospitalisation ‐ adults.
1.14
1.14. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 14 Length of ICU stay ‐ adults.
1.15
1.15. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 15 Length of hospitalisation ‐ children.
1.16
1.16. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 16 Pneumonia complications ‐ adults + children.
1.17
1.17. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 17 Secondary infections ‐ adults.
1.18
1.18. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 18 Secondary infections ‐ children.
1.19
1.19. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 19 Any adverse events ‐ adults.
1.20
1.20. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 20 Hyperglycaemia ‐ adults.
1.21
1.21. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 21 Gastrointestinal bleeding ‐ adults.
1.22
1.22. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 22 Neuropsychiatric side effects ‐ adults.
1.23
1.23. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 23 Adverse cardiac events ‐ adults.
1.24
1.24. Analysis
Comparison 1 Corticosteroids versus no treatment or placebo, Outcome 24 Any adverse events ‐ children.
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References

References to studies included in this review

Blum 2015 {published and unpublished data}
    1. Blum CA, Nigro N, Briel M, Schuetz P, Ullmer E, Suter‐Widmer I, et al. Adjunct prednisone therapy for patients with community‐acquired pneumonia: a multicentre, double‐blind, randomised, placebo‐controlled trial. Lancet 2015;385(9977):1511‐8. - PubMed
Confalonieri 2005 {published data only}
    1. Confalonieri M, Urbino R, Potena A, Piattella M, Parigi P, Puccio G. Hydrocortisone infusion for severe community‐acquired pneumonia: a preliminary randomised study. American Journal of Respiratory and Critical Care Medicine 2005;171(3):242‐8. - PubMed
El‐Ghamrawy 2006 {published data only}
    1. El‐Ghamrawy AH, Shokier MH, Esmat AA. Effects of low‐dose hydrocortisone in ICU patients with severe community‐acquired pneumonia. Egyptian Journal of Chest Diseases and Tuberculosis 2006;55:91‐9.
Fernández‐Serrano 2011 {published data only}
    1. Fernández‐Serrano S, Dorca J, Garcia‐Vidal C, Fernández‐Sabé N, Carratalà J, Fernández‐Agüera A, et al. Effect of corticosteroids on the clinical course of community‐acquired pneumonia: a randomized controlled trial. Critical Care 2011;15(2):R96. - PMC - PubMed
Hatakeyama 1995 {published data only}
    1. Hatakeyama S, Tachibana A, Suzuki K, Okano H. Treatment of aspiration pneumonia with low‐dose methylprednisolone and antibiotics. Japanese Journal of Thoracic Diseases 1998;33(1):51‐6. - PubMed
Luo 2014 {published data only}
    1. Luo Z, Luo J, Liu E, Xu X, Liu Y, Zeng F, et al. Effects of prednisolone on refractory Mycoplasma pneumoniae pneumonia in children. Pediatric Pulmonology 2014;49(4):377‐80. - PubMed
Marik 1993 {published data only}
    1. Marik P, Kraus P, Sribante J, Havlik I, Lipman J, Johnson DW. Hydrocortisone and tumour necrosis factor in severe community‐acquired pneumonia. A randomised controlled study. Chest 1993;104(2):389‐92. - PubMed
McHardy 1972 {published data only}
    1. McHardy VU, Schonell ME. Ampicillin dosage and use of prednisolone in treatment of pneumonia: co‐operative controlled trial. British Medical Journal 1972;4(5840):569‐73. - PMC - PubMed
Meijvis 2011 {published data only}
    1. Meijvis SC, Hardeman H, Remmelts HH, Heijligenberg R, Rijkers GT, Velzen‐Blad H, et al. Dexamethasone and length of hospital stay in patients with community‐acquired pneumonia: a randomised, double‐blind, placebo‐controlled trial. Lancet 2011;377(9782):2023‐30. - PubMed
Mikami 2007 {published data only}
    1. Mikami K, Suzuki M, Kitagawa H, Kawakami M, Hirota N, Yamaguchi H. Efficacy of corticosteroids in the treatment of community‐acquired pneumonia requiring hospitalisation. Lung 2007;185(5):249‐55. - PubMed
Nafae 2013 {published data only}
    1. Nafae RM, Ragab MI, Amany FM, Rashed SB. Adjuvant role of corticosteroids in the treatment of community‐acquired pneumonia. Egyptian Journal of Chest Diseases and Tuberculosis 2013;62(3):439–45.
Nagy 2013 {published data only}
    1. Nagy B, Gaspar I, Papp A, Bene Z, Nagy B Jr, Voko Z, et al. Efficacy of methylprednisolone in children with severe community acquired pneumonia. Pediatric Pulmonology 2013;48(2):168‐75. - PubMed
Sabry 2011 {published data only}
    1. Sabry NA, Omar EE. Corticosteroids and ICU course of community acquired pneumonia in Egyptian settings. Pharmacology & Pharmacy 2011;2:73‐81. [DOI: 10.4236/pp.2011.22009] - DOI
Snijders 2010 {published data only}
    1. Snijders D, Daniels JM, Graaff CS, Werf TS, Boersma WG. Efficacy of corticosteroids in community‐acquired pneumonia: a randomized double‐blinded clinical trial. American Journal of Respiratory and Critical Care Medicine 2010;181(9):975‐82. - PubMed
Torres 2015 {published and unpublished data}
    1. Torres A, Sibila O, Ferrer M, Polverino E, Menendez R, Mensa J, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community‐acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA 2015;313(7):677‐86. - PubMed
Van Woensel 2003 {published data only}
    1. Woensel JB, Aalderen WM, Weerd W, Jansen NJ. Dexamethasone for treatment of patients mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus. Thorax 2003;58(5):383‐7. - PMC - PubMed
Wu 2014 {published data only}
    1. Wu YJ, Sun J, Zhang JH, Feng LL. Clinical efficacy of adjuvant therapy with glucocorticoids in children with lobar pneumonia caused by Mycoplasma pneumoniae. Zhongguo Dang Dai Er Ke Za Zhi [Chinese Journal of Contemporary Pediatrics] 2014;16(4):401‐5. - PubMed

References to studies excluded from this review

Cao 2007 {published data only}
    1. Cao LF, Lu YM, Ma HG, Ma M. Budesonide inhaling auxiliary therapy after Mycoplasma pneumoniae infection of children. International Journal of Respiration 2007;27(8):567‐9.
Huang 2014 {published data only}
    1. Huang L, Gao X, Chen M. Early treatment with corticosteroids in patients with Mycoplasma pneumoniae pneumonia: a randomized clinical trial. Journal of Tropical Pediatrics 2014;60(5):338‐42. - PubMed
Montón 1999 {published data only}
    1. Montón C, Ewig S, Torres A, El‐Ebiary M, Filella X, Rañó A, et al. Role of glucocorticoids on inflammatory response in nonimmunosuppressed patients with pneumonia: a pilot study. European Respiratory Journal 1999;14(1):218‐20. - PubMed
Shan 2017 {published data only}
    1. Shan LS, Liu X, Kang XY, Wang F, Han XH, Shang YX. Effects of methylprednisolone or immunoglobulin when added to standard treatment with intravenous azithromycin for refractory Mycoplasma pneumoniae pneumonia in children. World Journal of Pediatrics 2017 Jan 27 [Epub ahead of print]. [DOI: 10.1007/s12519-017-0014-9] - DOI - PubMed
Van Woensel 2011 {published data only}
    1. Woensel JB, Vyas H, STAR Trial Group. Dexamethasone in children mechanically ventilated for lower respiratory tract infection caused by respiratory syncytial virus: a randomized controlled trial. Critical Care Medicine 2011;39(7):1779‐83. - PubMed
Wagner 1956 {published data only}
    1. Wagner HN Jr, Bennett IL Jr, Lasagna L, Cluff LE, Rosenthal MB, Mirick GS. The effect of hydrocortisone upon the course of pneumococcal pneumonia treated with penicillin. Bulletin of the Johns Hopkins Hospital 1956;98(3):197‐215. - PubMed

References to studies awaiting assessment

Lan 2015 {published data only}
    1. Lan Y, Yang D, Chen Z, Tang L, Xu Y, Cheng Y. Effectiveness of methylprednisolone in treatment of children with refractory Mycoplasma pneumoniae pneumonia and its relationship with bronchoalveolar lavage cytokine levels. Zhonghua Er Ke Za Zhi 2015;53(10):779‐83. - PubMed

References to ongoing studies

NCT01283009 {published and unpublished data}
    1. NCT01283009. Extended Steroid in CAP(e) (ESCAPe). clinicaltrials.gov/ct2/show/NCT01283009 (first received 21 January 2011).
NCT02618057 {published and unpublished data}
    1. NCT02618057. Effects of oral steroid in Mycoplasma pneumoniae pneumonia. clinicaltrials.gov/ct2/show/NCT02618057 (first received 8 November 2015).
NCT02735707 {published and unpublished data}
    1. NCT02735707. Randomized, embedded, multifactorial adaptive platform trial for community‐acquired pneumonia (REMAP‐CAP). clinicaltrials.gov/ct2/show/NCT02735707 (first received 11 December 2015).
NCT03121690 {published and unpublished data}
    1. NCT03121690. The applicability of different scoring systems and use of steroids in the treatment of hospital acquired pneumonia. clinicaltrials.gov/ct2/show/NCT03121690 (first received 10 April 2017).

Additional references

Annane 2004
    1. Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y. Corticosteroids for severe sepsis and septic shock: a systematic review and meta‐analysis. BMJ 2004;329(7464):480. - PMC - PubMed
Annane 2009
    1. Annane D, Bellissant E, Bollaert PE, Briegel J, Confalonieri M, Gaudio R, et al. Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review. JAMA 2009;301(22):2362. - PubMed
Atkins 2004
    1. Atkins D, Best D, Briss PA, Eccles M, Falck‐Ytter Y, Flottorp S, et al. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490. - PMC - PubMed
Avni 2015
    1. Avni T, Shiver‐Ofer S, Leibovici L, Tacconelli E, DeAngelis G, Cookson B, et al. Participation of elderly adults in randomized controlled trials addressing antibiotic treatment of pneumonia. Journal of the American Geriatrics Society 2015;63(2):233‐43. - PubMed
Brouwer 2015
    1. Brouwer MC, McIntyre P, Prasad K, Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database of Systematic Reviews 2015, Issue 9. [DOI: 10.1002/14651858.CD004405.pub5] - DOI - PMC - PubMed
BTS guidelines 1987
    1. British Thoracic Society. Community‐acquired pneumonia in adults in British hospitals in 1982‐1983: a survey of aetiology, mortality, prognostic factors and outcome. The British Thoracic Society and the Public Health Laboratory Service. Quarterly Journal of Medicine 1987;62(239):195‐220. - PubMed
Chalmers 2010
    1. Chalmers JD, Singanayagam A, Akram AR, Mandal P, Short PM, Choudhury G, et al. Severity assessment tools for predicting mortality in hospitalised patients with community‐acquired pneumonia. Systematic review and meta‐analysis. Thorax 2010;65(10):878‐83. - PubMed
Chawla 2008
    1. Chawla R. Epidemiology, etiology, and diagnosis of hospital‐acquired pneumonia and ventilator‐associated pneumonia in Asian countries. American Journal of Infection Control 2008;36(4 Suppl):S93‐100. - PubMed
Comprehensive Meta‐Analysis V3 [Computer program]
    1. Biostat. Comprehensive Meta‐Analysis V3.3.07. Version (accessed prior to 30 August 2017). Englewood (NJ): Biostat, 2014.
FDA CAP industry guidance
    1. FDA. Guidance for industry. Community‐acquired pneumonia ‐ developing antimicrobial drugs for treatment. www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guid... (accessed prior to 11 August 2017).
FDA HAP/VAP industry guidance
    1. FDA. Guidance for industry. Hospital‐acquired bacterial pneumonia and ventilator‐associated bacterial pneumonia: developing drugs for treatment. www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guid... (accessed prior to 11 August 2017).
File 2010
    1. File TM Jr, Marrie TJ. Burden of community‐acquired pneumonia in North American adults. Postgraduate Medicine 2010;122(2):130‐41. - PubMed
Fine 1997
    1. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low‐risk patients with community‐acquired pneumonia. New England Journal of Medicine 1997;336(4):243‐50. - PubMed
Friedman 2002
    1. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care‐associated bloodstream infections in adults: a reason to change the accepted definition of community‐acquired infections. Annals of Internal Medicine 2002;137(10):791‐7. - PubMed
GRADEpro GDT 2015 [Computer program]
    1. GRADE Working Group, McMaster University. GRADEpro GDT. Version (accessed prior to 30 August 2017). Hamilton (ON): GRADE Working Group, McMaster University, 2015.
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Horita 2015
    1. Horita N, Otsuka T, Haranaga S, Namkoong H, Miki M, Miyashita N, et al. Adjunctive systemic corticosteroids for hospitalized community‐acquired pneumonia: systematic review and meta‐analysis 2015 update. Scientific Reports 2015;5:14061. - PMC - PubMed
Jones 2010
    1. Jones RN. Microbial etiologies of hospital‐acquired bacterial pneumonia and ventilator‐associated bacterial pneumonia. Clinical Infectious Diseases 2010;51(Suppl 1):S81‐7. - PubMed
Kalil 2016
    1. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital‐acquired and ventilator‐associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinical Infectious Diseases 2016;63(5):e61‐111. - PMC - PubMed
Kaplan 2002
    1. Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde‐Zwirble WT. Hospitalized community‐acquired pneumonia in the elderly: age‐ and sex‐related patterns of care and outcome in the United States. American Journal of Respiratory and Critical Care Medicine 2002;165(6):766‐72. - PubMed
Krinsley 2003
    1. Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clinic Proceedings 2003;78(12):1471. - PubMed
Lee 2010
    1. Lee GE, Lorch SA, Sheffler‐Collins S, Kronman MP, Shah SS. National hospitalization trends for pediatric pneumonia and associated complications. Pediatrics 2010;126(2):204‐13. - PMC - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JP, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Lim 2009
    1. Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Jeune I, et al. Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009;64(Suppl 3):iii1. - PubMed
Magill 2014
    1. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Emerging Infections Program Healthcare‐Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point‐prevalence survey of health care‐associated infections. New England Journal of Medicine 2014;370(13):1198‐208. - PMC - PubMed
Mandell 2007
    1. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community‐acquired pneumonia in adults. Clinical Infectious Diseases 2007;44(Suppl 2):S27‐72. - PMC - PubMed
Mandell 2015
    1. Ellison RT 3rd, Donowitz GR. Acute pneumonia. In: Mandell GL, Bennett JE editor(s). Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th Edition. Vol. 1, London: Churchill Livingstone, 2015:823‐46.
Marik 2008
    1. Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, et al. American College of Critical Care Medicine. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Critical Care Medicine 2008;36(6):1937‐49. - PubMed
Marrie 2007
    1. Marrie TJ, Shariatzadeh MR. Community‐acquired pneumonia requiring admission to an intensive care unit: a descriptive study. Medicine 2007;86(2):103‐11. - PubMed
Marti 2015
    1. Marti C, Grosgurin O, Harbarth S, Combescure C, Abbas M, Rutschmann O, et al. Adjunctive corticotherapy for community acquired pneumonia: a systematic review and meta‐analysis. PLoS ONE 2015;10(12):e0144032. - PMC - PubMed
Moher 2009
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. Annals of Internal Medicine 2009;151(4):264‐9. - PubMed
Musher 2014
    1. Musher DM, Thorner AR. Community‐acquired pneumonia. New England Journal of Medicine 2014;271(17):1619‐28. - PubMed
Niederman 2007
    1. Niederman MS. Recent advances in community‐acquired pneumonia: inpatient and outpatient. Chest 2007;131(4):1205‐15. - PMC - PubMed
Oray 2016
    1. Oray M, Abu Samra K, Ebrahimiadib N, Meese H, Foster CS. Long‐term side effects of glucocorticoids. Expert Opinion on Drug Safety 2016;15(4):457‐65. - PubMed
Restrepo 2008
    1. Restrepo MI, Mortensen EM, Velez JA, Frei C, Anzueto A. A comparative study of community‐acquired pneumonia patients admitted to the ward and the ICU. Chest 2008;133(3):610‐7. - PubMed
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rhen 2005
    1. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids ‐ new mechanisms for old drugs. New England Journal of Medicine 2005;353(16):1711‐23. - PubMed
Rhodes 2017
    1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Critical Care Medicine 2017;45(3):486‐552. - PubMed
Rosenthal 2012
    1. Rosenthal VD, Bijie H, Maki DG, Mehta Y, Apisarnthanarak A, Medeiros EA, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004‐2009. American Journal of Infection Control 2012;40(5):396‐407. - PubMed
Ruan 2014
    1. Ruan SY, Lin HH, Huang CT, Kuo PH, Wu HD, Yu CJ. Exploring the heterogeneity of effects of corticosteroids on acute respiratory distress syndrome: a systematic review and meta‐analysis. Critical Care 2014;18(2):R63. - PMC - PubMed
Safdar 2005
    1. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator‐associated pneumonia: a systematic review. Critical Care Medicine 2005;33(10):2184‐93. - PubMed
Salluh 2008
    1. Salluh JI, Póvoa P, Soares M, Castro‐Faria‐Neto HC, Bozza FA, Bozza PT. The role of corticosteroids in severe community‐acquired pneumonia: a systematic review. Critical Care 2008;12(3):R76. - PMC - PubMed
Schäcke 2002
    1. Schäcke H, Döcke WD, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacology & Therapeutics 2002;96(1):23‐43. - PubMed
Siemieniuk 2015
    1. Siemieniuk RA, Meade MO, Alonso‐Coello P, Briel M, Evaniew N, Prasad M, et al. Corticosteroid therapy for patients hospitalized with community‐acquired pneumonia: a systematic review and meta‐analysis. Annals of Internal Medicine 2015;163(7):519‐28. - PubMed
Torres 2010
    1. Torres A, Ferrer M, Badia JR. Treatment guidelines and outcomes of hospital‐acquired and ventilator‐associated pneumonia. Clinical Infectious Diseases 2010;51(Suppl 1):S48‐53. - PubMed
Virkki 2002
    1. Virkki R, Juven T, Rikalainen H, Svedström E, Mertsola J, Ruuskanen O. Differentiation of bacterial and viral pneumonia in children. Thorax 2002;57(5):438‐41. - PMC - PubMed
Walters 2014
    1. Walters JA, Tan DJ, White CJ, Gibson PG, Wood‐Baker R, Walters EH. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2014, Issue 9. [DOI: 10.1002/14651858.CD001288.pub4] - DOI - PMC - PubMed
Wan 2014
    1. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Medical Research Methodology 2014;14:135. [DOI: 10.1186/1471-2288-14-135] - DOI - PMC - PubMed
Wan 2016
    1. Wan YD, Sun TW, Liu ZQ, Zhang SG, Wang LX, Kan QC. Efficacy and safety of corticosteroids for community‐acquired pneumonia: a systematic review and meta‐analysis. Chest 2016;149(1):209‐19. - PubMed
Warrington 2006
    1. Warrington TP, Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clinic Proceedings 2006;81(10):1361‐7. - PubMed
Wood 2008
    1. Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta‐epidemiological study. BMJ 2008;336(7644):601‐5. - PMC - PubMed
Wunderink 2015
    1. Wunderink RG. Corticosteroids for severe community‐acquired pneumonia: not for everyone. JAMA 2015;313(7):673‐4. - PubMed
Xu 2016
    1. Xu J, Murphy SL, Kochanek KD, Bastian BA. Deaths: Final Data for 2013. National Vital Statistics Reports 2016;64(2):1‐119. - PubMed

References to other published versions of this review

Chen 2011
    1. Chen Y, Li K, Pu H, Wu T. Corticosteroids for pneumonia. Cochrane Database of Systematic Reviews 2011, Issue 3. [DOI: 10.1002/14651858.CD007720.pub2] - DOI - PubMed

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