Efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia: A meta-analysis of randomized controlled trials

BACKGROUND: Community-acquired pneumonia (CAP) is pneumonia acquired infectiously from normal social contact as opposed to being acquired during hospitalization. CAP is a leading cause of illness and death. This review aims to determine the efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia (CAP). DATA SOURCES: We searched randomized controlled trials (RCTs) from Pubmed, EMBASE, Cochrane Library, Chinese Journal Full-text Database, and Chinese Biomedical Literature Database to obtain the information by using steroids, glucocorticoids, cortisol, corticosteroids, community-acquired pneumonia and CAP as key words. The quality of RCTs was evaluated. A Meta-analysis was made using RevMan 5.0 provided by the Cochrance Collaboration. RESULTS: Seven RCTs involving 944 patients were included in the meta-analysis. The mean length of hospital stay in glucocorticoids treatment group was significantly shorter than that in standard treatment group (WMD=-1.70, 95% CI 2.01-1.39, Z=10.81, P<0.00001). No statistically significant differences were found in the mortality rate (RR=0.77,95% CI 0.46-1.27, Z=1.03, P=0.30), the mean length of hospital stay in ICU (WMD=1.17, 95% CI 1.68-4.02, Z=0.81, P=0.42), the incidence of super infection (RR=1.32, 95% CI 0.66-2.63, Z=0.79, P=0.43), the incidence of hyperglycemia (RR=1.84, 95% CI 0.76-4.41, Z=1.36, P=0.17), the incidence of upper gastrointestinal bleeding (RR=1.98, 95% CI 0.37-10.59, Z=0.80, P=0.42) between the standard treatment group and the glucocorticoids treatment group. CONCLUSIONS: The use of glucocorticoids in patients with community-acquired pneumonia can significantly shorten the duration of illness and have a favorable safety profile. However, it could not reduce the overall mortality.