Comparing the efficacy of corticosteroids among patients with community-acquired pneumonia in the ICU versus non-ICU settings: A systematic review and meta-analysis

IF 2.1 4区医学 Q4 BIOCHEMISTRY & MOLECULAR BIOLOGY Steroids Pub Date : 2024-02-13 DOI:10.1016/j.steroids.2024.109389

Luis A. Diaz Caballero , Ashnah Aijaz , Neha Saleem Paryani , Samar Mahmood , Madiha Salman , Mohammad Omer Khan , Dayal Ahluwalia , Mohammad Arham Siddiq , Ishaque Hameed

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Abstract

Background

Despite the potential of corticosteroids in treating community-acquired pneumonia (CAP), conflicting evidence exists regarding their effect on mortality. To address this gap and provide new insights, we conducted a pre-specified subgroup meta-analysis of corticosteroid use in CAP patients, focusing on the ICU versus non-ICU subsets.

Methods

We searched PubMed, Cochrane Central Register of Controlled Trials and SCOPUS from inception to May 2023 for randomized controlled trials (RCTs). The primary outcomes of interest were mortality, need for mechanical ventilation, need for ICU admission, and treatment failure. Secondary outcomes analysed were the need for hospital readmission, length of hospital stay, length of ICU stay, gastrointestinal (GI) bleeding, secondary infections, and hyperglycaemic events. The results were analysed through the random-effects model. A p-value < 0.05 was considered significant.

Results

Eighteen randomized controlled trials (n = 4472) analyzing patients with CAP were included. Our results suggest that corticosteroids significantly reduced the incidence of mortality (RR: 0.66; 95 % CI: 0.54, 0.81; P = <0.0001) and need for mechanical ventilation (RR: 0.57; 95 % CI: 0.44, 0.73; P = <0.00001). It was also observed that corticosteroids significantly decrease the lengths of ICU (MD: −1.67; 95 % CI: −2.97, −0.37; P = 0.01) and hospital stay (MD: −1.94; 95 % CI: −2.89, −0.98; P = 0.0001), while increasing the number of hyperglycemic events (RR: 1.68; 95 % CI: 1.32, 2.12; P = <0.0001) and hospital readmissions (RR: 1.19; 95 % CI: 1.04, 1.37; P = 0.01).

Conclusions

The results of this meta-analysis demonstrate that corticosteroids yield improved outcomes in CAP patients with regard to reduced mortality and the need for mechanical ventilation. It highlights the need for further large-scale RCTs with the proposed, specific stratifications.

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比较重症监护病房与非重症监护病房社区获得性肺炎患者使用皮质类固醇的疗效：系统回顾和荟萃分析

背景尽管皮质类固醇具有治疗社区获得性肺炎（CAP）的潜力，但关于其对死亡率的影响却存在相互矛盾的证据。为了填补这一空白并提供新的见解，我们对 CAP 患者使用皮质类固醇的情况进行了预先指定的亚组荟萃分析，重点关注 ICU 与非 ICU 亚组。主要研究结果包括死亡率、机械通气需求、入住重症监护室需求和治疗失败。次要分析结果包括再入院需求、住院时间、重症监护室住院时间、消化道（GI）出血、继发感染和高血糖事件。结果通过随机效应模型进行分析。结果共纳入 18 项随机对照试验（n = 4472），对 CAP 患者进行了分析。结果表明，皮质类固醇可明显降低死亡率（RR：0.66；95 % CI：0.54，0.81；P = <0.0001）和机械通气需求（RR：0.57；95 % CI：0.44，0.73；P = <0.00001）。研究还发现，皮质类固醇可明显缩短重症监护室（MD：-1.67；95 % CI：-2.97，-0.37；P = 0.01）和住院时间（MD：-1.94；95 % CI：-2.89，-0.98；P = 0.0001），同时增加高血糖事件的次数（RR：1.68；95 % CI：1.结论这项荟萃分析结果表明，皮质类固醇可改善 CAP 患者的预后，降低死亡率和机械通气需求。荟萃分析结果表明，皮质类固醇可改善 CAP 患者的预后，降低死亡率和机械通气需求。

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来源期刊

Steroids 医学-内分泌学与代谢

CiteScore

5.10

自引率

3.70%

发文量

120

审稿时长

73 days

期刊介绍： STEROIDS is an international research journal devoted to studies on all chemical and biological aspects of steroidal moieties. The journal focuses on both experimental and theoretical studies on the biology, chemistry, biosynthesis, metabolism, molecular biology, physiology and pharmacology of steroids and other molecules that target or regulate steroid receptors. Manuscripts presenting clinical research related to steroids, steroid drug development, comparative endocrinology of steroid hormones, investigations on the mechanism of steroid action and steroid chemistry are all appropriate for submission for peer review. STEROIDS publishes both original research and timely reviews. For details concerning the preparation of manuscripts see Instructions to Authors, which is published in each issue of the journal.