Efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia: A meta-analysis of randomized controlled trials

doi:10.5847/wjem.j.1920-8642.2015.03.002

Abstract

Abstract:

BACKGROUND: Community-acquired pneumonia (CAP) is pneumonia acquired infectiously from normal social contact as opposed to being acquired during hospitalization. CAP is a leading cause of illness and death. This review aims to determine the efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia (CAP).
DATA SOURCES: We searched randomized controlled trials (RCTs) from Pubmed, EMBASE, Cochrane Library, Chinese Journal Full-text Database, and Chinese Biomedical Literature Database to obtain the information by using steroids, glucocorticoids, cortisol, corticosteroids, community-acquired pneumonia and CAP as key words. The quality of RCTs was evaluated. A Meta-analysis was made using RevMan 5.0 provided by the Cochrance Collaboration.
RESULTS: Seven RCTs involving 944 patients were included in the meta-analysis. The mean length of hospital stay in glucocorticoids treatment group was significantly shorter than that in standard treatment group (WMD=-1.70, 95%CI 2.01-1.39, Z=10.81, P<0.00001). No statistically significant differences were found in the mortality rate (RR=0.77,95%CI 0.46-1.27, Z=1.03, P=0.30), the mean length of hospital stay in ICU (WMD=1.17, 95%CI 1.68-4.02, Z=0.81, P=0.42), the incidence of super infection (RR=1.32, 95%CI 0.66-2.63, Z=0.79, P=0.43), the incidence of hyperglycemia (RR=1.84, 95%CI 0.76-4.41, Z=1.36, P=0.17), the incidence of upper gastrointestinal bleeding (RR=1.98, 95%CI 0.37-10.59, Z=0.80, P=0.42) between the standard treatment group and the glucocorticoids treatment group.
CONCLUSIONS: The use of glucocorticoids in patients with community-acquired pneumonia can significantly shorten the duration of illness and have a favorable safety profile. However, it could not reduce the overall mortality.

Key words: Glucocorticoids, Community-acquired pneumonia, Meta-analysis

Li-ping Chen, Jun-hui Chen, Ying Chen, Chao Wu, Xiao-hong Yang. Efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia: A meta-analysis of randomized controlled trials[J]. World Journal of Emergency Medicine, 2015, 6(3): 172-178.

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References	Correctness of randomized studies	Correctness of allocation concealment methods	Blinding method taken or not	Deviation caused by data deficiency or not	Deviation caused by selective reports or not	Deviation caused by others
Snijders et al^[7]	Unclear	Unclear	Yes	No	No	No
Remmelts et al^[8]	Unclear	Unclear	Yes	No	No	No
Confalonieri et al^[9]	Yes	Yes	Yes	No	No	No
Mikami et al^[10]	Unclear	Unclear	Yes	No	No	No
Marik et al^[11]	Yes	Unclear	Yes	No	No	No
Meijvis et al^[12]	Yes	Yes	Yes	No	No	No
Fernández-Serrano et al^[13]	Yes	Yes	Yes	No	No	No

References	Year	Country	Hospital scale	Research design	Total (Test/control)
Snijders et al^[7]	2010	Holland	A teaching hospital with 900 beds	Random control single center	213 (104/109)
Remmelts et al^[8]	2012	Holland	Three hospitals, 1 of them is teaching hospital	Random control multicenter	275 (131/144)
Confalonieri et al^[9]	2005	Italy	Six hospitals	Random control multicenter	46 (23/23)
Mikami et al^[10]	2007	Japan	General hospital in community	Random control single center	31 (15/16)
Marik et al^[11]	2008	South Africa	Multidisciplinary ICU tertiary care teaching hospital	Random control single center	30 (14/16)
Meijvis et al^[12]	2011	Holland	Two teaching hospitals	Random control multicenter	304 (151/153)
Fernández-Serranoet al^[13]	2011	Spain	A hospital with 900 beds	Random control single center	45 (23/22)

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