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Meta-Analysis
. 2024 Jan 22;11(1):e002141.
doi: 10.1136/bmjresp-2023-002141.

Impact of different corticosteroids on severe community-acquired pneumonia: a systematic review and meta-analysis

Xin Ya See #  1 , Tsu Hsien Wang #  2 , Yu-Cheng Chang #  3 , Juien Lo  4 , Weitao Liu  5 , Cheryn Yu Wei Choo  6 , Yu-Che Lee  7 , Kevin Sheng Kai Ma  8 , Cho-Hsien Chiang  9 , Yuan Ping Hsia  10 , Cho-Hung Chiang  11 , Cho-Han Chiang  12
Affiliations
Meta-Analysis

Impact of different corticosteroids on severe community-acquired pneumonia: a systematic review and meta-analysis

Xin Ya See et al. BMJ Open Respir Res. .

Abstract

Objectives: Randomised controlled trials (RCTs) have demonstrated conflicting results regarding the effects of corticosteroids on the treatment of severe community-acquired pneumonia (CAP). We aimed to investigate the efficacy and safety of different corticosteroids on patients who were hospitalised for severe CAP.

Methods: We performed a systematic search through PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to May 2023. The primary outcome was all-cause mortality. Data analysis was performed using a random-effects model.

Results: A total of 10 RCTs comprising 1962 patients were included. Corticosteroids were associated with a lower rate of all-cause mortality (risk ratio (RR), 0.70 (95% CI 0.54 to 0.90); I2=0.00%). When stratified into different corticosteroid types, hydrocortisone was associated with an approximately 50% lower mortality risk (RR, 0.48 (95% CI 0.32 to 0.72); I2=0.00%). However, dexamethasone, methylprednisolone or prednisolone were not associated with an improvement in mortality. Furthermore, hydrocortisone was associated with a reduction in the rate of mechanical ventilation, acute respiratory distress syndrome, shock and duration of intensive care unit stay. These trends were not observed for dexamethasone, methylprednisolone or prednisolone. Corticosteroids were not associated with an increased risk of adverse events including gastrointestinal bleeding, secondary infection or hyperglycaemia.

Conclusions: The use of hydrocortisone, but not other types of corticosteroids, was associated with a reduction in mortality and improvement in pneumonia outcomes among patients hospitalised with severe CAP.PROSPERO registration numberCRD42023431360.

Keywords: Critical Care; Pneumonia; Respiratory Infection.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart showing the process of systematic review. CAP, community-acquired pneumonia.
Figure 2
Figure 2
Forest plot summarising the effects of corticosteroids on all-cause mortality. Note: The inconsistency index (I2) statistic indicates the extent of inter-study heterogeneity.
See this image and copyright information in PMC

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