Patients who were randomized to corticosteroids had a shorter duration of IV antibiotics than those on placebo, but they also had more hyperglycemia and readmissions, according to a meta-analysis.

FINDINGS:

Corticosteroids for patients hospitalized with community-acquired pneumonia (CAP) reduced length of stay but had no significant effect on overall mortality and increased risk for readmission and hyperglycemia, according to a systematic review and meta-analysis.

To evaluate the benefits and harms of adjunctive corticosteroids in CAP, researchers reviewed the literature through July 2017 to develop a cohort of 1,506 patients (748 patients randomized to corticosteroids and 758 patients to placebo) from six trials.

The primary outcome was 30-day mortality. Secondary outcomes were ICU admission, length of hospital stay, early (<72 hours) and late (>72 hours) treatment failure, CAP-related readmission within 30 days after discharge, duration of IV antibiotics, side effects of corticosteroids, and development of empyema. Results were published online Sept. 9 by Clinical Infectious Diseases. 

RESULTS:

Within 30 days, 37 of 748 patients (5.0%) assigned to corticosteroids and 45 of 758 patients (5.9%) assigned to placebo had died (adjusted odds ratio [OR], 0.75; 95% CI, 0.46 to 1.21; P=0.24). Time to clinical stability and length of hospital stay were reduced by approximately one day with corticosteroids: −1.03 days (95% CI, −1.62 to −0.43; P=0.001) for the former and −1.15 days (95% CI, −1.75 to −0.55; P<0.001) for the latter. Patients in the corticosteroid groups had a shorter duration of IV antibiotics than the placebo groups (adjusted mean difference, −0.62 day; 95% CI, −1.07 to −0.16 days; P=0.01). Rates of secondary ICU admission, early treatment failure, and late treatment failure were similar in the treatment groups. 

More patients with corticosteroids had hyperglycemia requiring insulin (22.1% vs. 12.0%; adjusted OR, 2.15 [95% CI, 1.60 to 2.90] P<0.001; number needed to harm [NNH], 9 [95% CI, 6 to 17]) and CAP-related rehospitalization (5.0% vs. 2.7%; adjusted OR, 1.85 [95% CI, 1.03 to 3.32] P=0.04; NNH, 45 [95% CI, 18 to 1,235]). No significant effect modification was found by CAP severity or degree of inflammation.

The authors noted that the total cost of CAP is over €10 billion per year in Europe, much of which is related to in-hospital care, so a reduction in length of stay by 12.5% would have considerable economic impact. “This advantage of adjunct corticosteroid therapy, however, may need to be balanced against a possible increase in CAP-related readmissions (NNH of 45),” they wrote. “Only an economic analysis can answer the question if adjunctive corticosteroids in CAP are cost-effective.”