Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials
Abstract Background This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of systemic corticosteroids in the treatment of patients with severe community-acquired pneumonia (sCAP). Methods A comprehensive search was conducted using the Medline, Embase, Clinica...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04561-z |
| _version_ | 1797675300779196416 |
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| author | Jheng-Yan Wu Ya-Wen Tsai Wan-Hsuan Hsu Ting-Hui Liu Po-Yu Huang Min-Hsiang Chuang Mei-Yuan Liu Chih-Cheng Lai |
| author_facet | Jheng-Yan Wu Ya-Wen Tsai Wan-Hsuan Hsu Ting-Hui Liu Po-Yu Huang Min-Hsiang Chuang Mei-Yuan Liu Chih-Cheng Lai |
| author_sort | Jheng-Yan Wu |
| collection | DOAJ |
| description | Abstract Background This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of systemic corticosteroids in the treatment of patients with severe community-acquired pneumonia (sCAP). Methods A comprehensive search was conducted using the Medline, Embase, ClinicalTrials.gov, and Scopus databases for articles published until April 24, 2023. Only randomized controlled trials (RCTs) that assessed the clinical efficacy and safety of adjunctive corticosteroids for treating sCAP were included. The primary outcome was the 30-day all-cause mortality. Results A total of severe RCTs involving 1689 patients were included in this study. Overall, the study group had a lower mortality rate at day 30 than the control group (risk ratio [RR], 0.61; 95% CI 0.44 to 0.85; p < 0.01) with low heterogeneity (I 2 = 0%, p = 0.42). Compared to the control group, the study group had a lower risk of the requirement of mechanical ventilation (RR 0.57; 95% CI 0.45 to 0.73; p < 0.001), shorter length of intensive care unit (MD − 0.8; 95% CI − 1.4 to − 0.1; p = 0.02), and hospital stay (MD − 1.1; 95% CI − 2.0 to − 0.1; p = 0.04). Finally, no significant difference was observed between the study and the control groups in terms of gastrointestinal tract bleeding (RR 1.03; 95% CI 0.49 to 2.18; p = 0.93), healthcare-associated infection (RR 0.89; 95% CI 0.60 to 1.32; p = 0.56), and acute kidney injury (RR 0.68; 95% CI 0.21 to 2.26; p = 0.53). Conclusions In patients with sCAP, adjunctive corticosteroids can provide survival benefits and improve clinical outcomes without increasing adverse events. However, because the pooled evidence remains inconclusive, further studies are required. |
| first_indexed | 2024-03-11T22:12:48Z |
| format | Article |
| id | doaj.art-34a7a69bbabe4ccabee3d7b343b560fb |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-11T22:12:48Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-34a7a69bbabe4ccabee3d7b343b560fb2023-09-24T11:21:03ZengBMCCritical Care1364-85352023-07-0127111110.1186/s13054-023-04561-zEfficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trialsJheng-Yan Wu0Ya-Wen Tsai1Wan-Hsuan Hsu2Ting-Hui Liu3Po-Yu Huang4Min-Hsiang Chuang5Mei-Yuan Liu6Chih-Cheng Lai7Department of Nutrition, Chi Mei Medical CenterCenter of Integrative Medicine, Chi Mei Medical CenterDepartment of Internal Medicine, Chi Mei Medical CenterDepartment of Psychiatry, Chi Mei Medical CenterDepartment of Internal Medicine, Chi Mei Medical CenterDepartment of Internal Medicine, Chi Mei Medical CenterDepartment of Nutrition, Chi Mei Medical CenterDivision of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical CenterAbstract Background This systematic review and meta-analysis aimed to investigate the clinical efficacy and safety of systemic corticosteroids in the treatment of patients with severe community-acquired pneumonia (sCAP). Methods A comprehensive search was conducted using the Medline, Embase, ClinicalTrials.gov, and Scopus databases for articles published until April 24, 2023. Only randomized controlled trials (RCTs) that assessed the clinical efficacy and safety of adjunctive corticosteroids for treating sCAP were included. The primary outcome was the 30-day all-cause mortality. Results A total of severe RCTs involving 1689 patients were included in this study. Overall, the study group had a lower mortality rate at day 30 than the control group (risk ratio [RR], 0.61; 95% CI 0.44 to 0.85; p < 0.01) with low heterogeneity (I 2 = 0%, p = 0.42). Compared to the control group, the study group had a lower risk of the requirement of mechanical ventilation (RR 0.57; 95% CI 0.45 to 0.73; p < 0.001), shorter length of intensive care unit (MD − 0.8; 95% CI − 1.4 to − 0.1; p = 0.02), and hospital stay (MD − 1.1; 95% CI − 2.0 to − 0.1; p = 0.04). Finally, no significant difference was observed between the study and the control groups in terms of gastrointestinal tract bleeding (RR 1.03; 95% CI 0.49 to 2.18; p = 0.93), healthcare-associated infection (RR 0.89; 95% CI 0.60 to 1.32; p = 0.56), and acute kidney injury (RR 0.68; 95% CI 0.21 to 2.26; p = 0.53). Conclusions In patients with sCAP, adjunctive corticosteroids can provide survival benefits and improve clinical outcomes without increasing adverse events. However, because the pooled evidence remains inconclusive, further studies are required.https://doi.org/10.1186/s13054-023-04561-zCommunity-acquired pneumoniaCorticosteroidMortalityHydrocortisoneIntensive care unit |
| spellingShingle | Jheng-Yan Wu Ya-Wen Tsai Wan-Hsuan Hsu Ting-Hui Liu Po-Yu Huang Min-Hsiang Chuang Mei-Yuan Liu Chih-Cheng Lai Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials Critical Care Community-acquired pneumonia Corticosteroid Mortality Hydrocortisone Intensive care unit |
| title | Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials |
| title_full | Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials |
| title_short | Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials |
| title_sort | efficacy and safety of adjunctive corticosteroids in the treatment of severe community acquired pneumonia a systematic review and meta analysis of randomized controlled trials |
| topic | Community-acquired pneumonia Corticosteroid Mortality Hydrocortisone Intensive care unit |
| url | https://doi.org/10.1186/s13054-023-04561-z |
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