Steroids benefit patients hospitalized with pneumonia

By John Murphy, MDLinx
Published January 6, 2016

Key Takeaways

In hospitalized adults with community-acquired pneumonia, systemic corticosteroid therapy can reduce the need for mechanical ventilation by approximately 5%, shorten hospital stay by approximately 1 day, and possibly reduce mortality by approximately 3%, according to a study published August 10, 2015 in the Annals of Internal Medicine.

The review and meta-analysis—led by investigators at McMaster University’s Michael G. DeGroote School of Medicine in Hamilton, Ontario, Canada, along with a number of international collaborators—summarized the evidence from 13 randomized trials involving more than 2,000 patients.

“Our study should lead to an important change in treatment for pneumonia,” said lead author Reed Siemieniuk, MD, a physician and a graduate student at McMaster University. “Corticosteroids are inexpensive and readily available around the world. Millions of patients will benefit from this new evidence.”

In some studies included in their meta-analysis, corticosteroid therapy reduced inflammatory response and decreased the frequency of acute respiratory distress syndrome, sepsis, and mortality. But, given the potential adverse effects of corticosteroids, their use has also been controversial. The current analysis aimed to bring cohesion to previous findings.

Combined evidence from the randomized trials showed that patients with community-acquired pneumonia who received corticosteroids were discharged 1 day sooner. Corticosteroid treatment also reduced the need for mechanical ventilation from 9% to 5% these patients, and lessened the likelihood of acute respiratory distress syndrome from 8% to 2% of patients. The results also raised the possibility of a significant reduction in death rates from 9%-10% down to 5%-6% of patients.

“Seldom do we see a major advance in treatment of a condition as common as community-acquired pneumonia,” said the study’s senior investigator Gordon Guyatt, MD, MSc, professor of clinical epidemiology and biostatistics at McMaster.

The researchers did not report which specific treatment regimen worked best because the trials included in their analysis used various agents, routes of administration, and doses. Also, these trials often excluded patients at high risk for adverse events from corticosteroids. Adjunctive corticosteroids increased the frequency of hyperglycemia requiring treatment, they found, but did not increase the frequency of gastrointestinal hemorrhage.

All in all, “corticosteroids over short periods are safe, and we now know that they achieve important benefits in a serious and common medical illness,” Dr. Guyatt said.

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