Corticosteroids for adult patients hospitalised with non-viral community-acquired pneumonia: a systematic review and meta-analysis

PurposeInternational clinical practice guidelines addressing corticosteroid treatment for patients hospitalised with non-viral community-acquired pneumonia (CAP) are inconsistent.MethodsWe conducted a systematic review of randomized controlled trials (RCTs) evaluating the use of corticosteroids in hospitalised adult patients with suspected or probable CAP. We performed random effects pairwise, Bayesian, and dose-response meta-analyses using the restricted maximum likelihood (REML) heterogeneity estimator. We assessed certainty of evidence using GRADE methodology.ResultsWe identified 30 eligible RCTs, including a total of 7519 patients. The prednisone-equivalent doses ranged between 29 mg/day and 100 mg/day. Corticosteroids probably reduced short-term (28-30 days) mortality (RR 0.82 [95% CI 0.74-0.91]; moderate certainty) while the reduction in longer term (60-90 day) mortality is less certain (RR 0.89 [95% CI 0.76-1.03]; low certainty). Corticosteroids reduced the need for invasive mechanical ventilation (IMV) (RR 0.63 [95% CI 0.48-0.82]; high certainty) and may reduce duration of ICU stay (MD 1.53 days fewer [95% CI 0.31-2.75 days fewer]; low certainty), and hospital stay (MD 2.30 days fewer [95% CI 0.81-3.81 days fewer]; low certainty). Corticosteroids probably increased hyperglycaemia requiring intervention (RR 1.32 [95% CI 1.12-1.56]; moderate certainty) but probably have no effect on secondary infections (RR 0.97 [95% CI 0.85-1.11]; moderate certainty).ConclusionCorticosteroids probably reduced short-term mortality and reduce the need for invasive mechanical ventilation in hospitalised patients with CAP.PROSPERO registration numberCRD42024521536.