Clinical value of glucocorticoids for severe community-acquired pneumonia: A systematic review and meta-analysis based on randomized controlled trials

Abstract

Background: Severe community-acquired pneumonia (sCAP) is characterized by severe symptoms and a poor prognosis, especially with the recent global impact of novel coronavirus in recent years. The use of glucocorticoids in sCAP is currently a subject of debate. To evaluate the clinical efficacy and safety of glucocorticoids and provide guidance for their rational use in clinical practice, we conducted this study. Methods: We searched PubMed, Web of Science, and China National Knowledge Infrastructure using the following search terms: “pneumonia”, “pneumonias”, “Pulmonary Inflammation”, “Pulmonary Inflammations”, “Lung Inflammation”, and “Lung Inflammations”. The primary outcomes included mortality and the length of hospital stay. The secondary outcomes included the duration of mechanical ventilation, duration of vasoactive drug use, gastrointestinal bleeding, and multiple infections. The Cochrane Collaboration was used to assess the risk of bias of the included studies. Stata/MP14 was used for meta-analysis. Results: These studies contained information on 1252 patients who received glucocorticoids and 1280 patients who did not. Meta-analysis showed that there was no difference in terms of mortality [risk ratio (RR) = 0.93, 95% confidence interval (CI): 0.81–1.07, P  > .05], gastrointestinal bleeding (RR = 1.38, 95% CI: 0.83–2.30, P  <  .05), multiple infections (RR = 1.17, 95% CI: 0.90–1.53, P  > .05) and length of hospital stay (mean difference [MD] = −0.87, 95% CI: −2.35 to 0.61, P  > .05) between the hormonal and nonhormonal groups. However, there was a significant difference in the duration of mechanical ventilation (MD = −1.54; 95% CI, −1.89 to −1.12, P  <  .05) and the duration of use of vasoactive drugs (MD = −14.09, 95% CI: −15.72 to −12.46, P < .05). Conclusion: Glucocorticoids reduced the duration of mechanical ventilation duration and vasoactive drug use in sCAP patients without increasing the risk of adverse events including hyperglycemia and multiple infections. However, there was no significant difference in mortality or length of hospital stay in sCAP patients between glucocorticoid and non-glucocorticoid groups. Glucocorticoids could be recommended for patients with sCAP with respiratory failure or hemodynamic instability.