Efficacy and Safety of Adjunctive Corticosteroids Therapy for Severe Community-Acquired Pneumonia in Adults: An Updated Systematic Review and Meta-Analysis

被引:41
作者
Bi, Jirui [1 ]
Yang, Jin [1 ]
Wang, Ying [1 ]
Yao, Cijiang [2 ]
Mei, Jing [1 ]
Liu, Ying [2 ]
Cao, Jiyu [3 ]
Lu, Youjin [1 ]
机构
[1] Anhui Med Univ, Affiliated Hosp 2, Dept Resp Med, Hefei, Peoples R China
[2] Anhui Med Univ, Sch Publ Hlth, Hefei, Peoples R China
[3] Anhui Med Univ, Sch Publ Hlth, Teaching Ctr Prevent Med, Hefei, Peoples R China
关键词
INTENSIVE-CARE-UNIT; ANTIBIOTIC-THERAPY; PREDICTION RULE; GLUCOCORTICOIDS; HYDROCORTISONE; DEXAMETHASONE; MANAGEMENT; LENGTH; STAY;
D O I
10.1371/journal.pone.0165942
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Adjunctive corticosteroids therapy is an attractive option for community-acquired pneumonia (CAP) treatment. However, the effectiveness of adjunctive corticosteroids on mortality of CAP remains inconsistent, especially in severe CAP. We performed a meta-analysis to evaluate the efficacy and safety of adjunctive corticosteroids in severe CAP patients. Methods Three databases of PubMed, EMBASE and Cochrane Library were searched for related studies published in English up to December, 2015. Randomized controlled trials (RCTs) of corticosteroids in hospitalized adults with severe CAP were included. Meta-analysis was performed by a random-effect model with STATA 11.0 software. We estimated the summary risk ratios (RRs) or effect size (ES) with its corresponding 95% confidence interval (95% CI) to assess the outcomes. Results We included 8 RCTs enrolling 528 severe CAP patients. Adjunctive corticosteroids significantly reduced all-cause mortality (RR = 0.46, 95% CI: 0.28 to 0.77, p = 0.003), risk of adult respiratory distress syndrome (ARDS) (RR = 0.23, 95% CI: 0.07 to 0.80, p = 0.02) and need for mechanical ventilation (RR = 0.50, 95% CI: 0.27 to 0.92, p = 0.026). Adjunctive corticosteroids did not increase frequency of hyperglycemia requiring treatment (RR = 1.03, 95% CI: 0.61 to 1.72, p = 0.91) or gastrointestinal hemorrhage (RR = 0.66, 95% CI: 0.19 to 2.31, p = 0.52). In subgroup analysis by duration of corticosteroids, we found that prolonged corticosteroids therapy significantly reduced all-cause mortality (RR = 0.41, 95% CI: 0.20 to 0.83, p = 0.01) and length of hospital stay (-4.76 days, 95% CI:-8.13 to -1.40, p = 0.006). Conclusions Results from this meta-analysis suggested that adjunctive corticosteroids therapy was safe and beneficial for severe CAP. In addition, prolonged corticosteroids therapy was more effective. These results should be confirmed by adequately powered studies in the future.
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页数:15
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