Briel M, et al. - This research entailed a scrutiny of the benefits and harms of adjunctive corticosteroids in adults hospitalized with community-acquired pneumonia (CAP) with the aid of data extracted from randomized, placebo-controlled trials. Furthermore, experts contemplated the subgroup differences. A reduction was achieved in the time to clinical stability and length of hospital stay by approximately 1 day without a notable effect on the overall mortality as a result of adjunct corticosteroids for patients hospitalized with CAP. However, findings disclosed an increased risk of CAP–related rehospitalization and hyperglycemia.

Methods

• An inquiry was carried out of the Medline, Embase, Cochrane Central, and trial registers (all through July 2017).
• Researchers examined the data of 1,506 individual patients in 6 trials, with the aid of uniform outcome definitions.
• Using multivariable hierarchical regression, they inspected the prespecified effect modifiers, adjusting for pneumonia severity, age, and clustering effects.

Results

• Death was reported in 37 of 748 patients (5.0%) assigned to corticosteroids and 45 of 758 patients (5.9%) assigned to placebo (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], .46 to 1.21; P=.24), within 30 days of randomization.
• Findings unveiled a reduction in the time to clinical stability and length of hospital stay by approximately 1 day with corticosteroids (-1.03 days; 95% CI, -1.62 to -.43; P=.001 and -1.15 days; 95% CI, -1.75 to -.55; P < .001, respectively).
• As per the outcomes, more patients with corticosteroids presented with hyperglycemia (160 [22.1%] vs 88 [12.0%]; aOR, 2.15; 95% CI, 1.60 to 2.90; P < .001) and CAP-related rehospitalization (33 [5.0%] vs 18 [2.7%]; aOR, 1.85; 95% CI, 1.03 to 3.32; P=.04).
• No prominent effect modification was detected through CAP severity or degree of inflammation.