Efficacy and safety of glucocorticoids therapy of severe community-acquired pneumonia in older adults: a systematic review and meta-analysis.

Abstract

Background: The use of corticosteroids in older adult patients with severe community-acquired pneumonia (sCAP) remains controversial. This meta-analysis aimed to thoroughly assess the efficacy and safety of corticosteroids in the treatment of older adult patients with sCAP.

Methods: We performed a comprehensive search in Public Medline, Excerpta Medica Database, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and SinoMed, covering records from the earliest available to September 15, 2024. Randomized controlled trials (RCTs) were conducted. The primary outcome was 30-day all-cause mortality, with safety outcomes including gastrointestinal bleeding, secondary infections, and acute kidney injury.

Results: This meta-analysis included data from nine RCTs with 2,034 patients, showing that corticosteroid therapy was associated with lower 30-day all-cause mortality (risk ratio (RR) = 0.67; 95% confidence interval [CI], 0.52-0.86; P = 0.002). Corticosteroid use also shortens hospital and intensive care unit stays, reduces mechanical ventilation requirements, lowers vasopressor dependence, and decreases C-reactive protein levels. Regarding safety, corticosteroids did not significantly increase risks of superinfection (RR = 0.78; 95% CI, 0.54-1.13; P = 0.19), upper gastrointestinal bleeding (RR = 0.71; 95% CI, 0.35-1.44; P = 0.34), or acute kidney injury (RR = 0.71; 95% CI, 0.23-2.21; P = 0.56).

Conclusions: This meta-analysis demonstrated that glucocorticoid use is associated with higher survival in older patients with sCAP; however, the safety outcomes remain uncertain due to variability in study definitions.

Trial registration: PROSPERO CRD 42024591076 was successfully registered on September 30, 2024.