Category: Critical Care
Keywords: community acquired pneumonia; CAP; corticosteroids; mortality; adjuvant therapy (PubMed Search)
Posted: 3/25/2025 by Quincy Tran, MD, PhD
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If you watch those medical drama (House MD, ER, Grey’s Anatomy, Resident…), the doctors and residents are always faced with a dilemma – is it a rare autoimmune disorder or is it an infection? They are worried that if they give steroid to a patient with infections, that would kill the patients.
Well, it might not be the case for Community acquired pneumonia.
A meta-analysis of randomized control trials involving 3224 patients to look into the efficacy of adjuvant corticosteroids for CAP. The authors assessed the heterogeneity of treatment effect (different groups should have different response to treatment).
For patients who were anticipated to benefit (those who had CRP > 240 mg/L), corticosteroids were associated with lower odds of 30-day mortality (OR 0·43 [0·25–0·76], p=0·026).
When stratifying by risk, there was no significant effect between those with Pneumonia Severity Index (PSI) I-III versus those with PSI IV-V.
However, corticosteroids increased odds of hyperglycemia (OR 2·50 [95% CI 1·63–3·83], p<0·0001), odds of hospital readmissions (1·95 [1·24–3·07], p=0·0038)
Discussion:
There were different regiments for corticosteroids in the included studies. However, hydrocortisone appeared to be more effective than other corticosteroids.
Furthermore, the time intervals for treatment is still debatable. The data suggested that the ideal treatment is within 24 hours of hospital admission, but patients can still benefit from treatment in up to 48 hours.
A response-dependent treatment is also recommended: 8 days or 14 days, depending on how patients respond to treatment by day 4.
Conclusion:
Adjuvant treatment with corticosteroids among hospitalized patients with CAP was significantly associated with reduction of 30-day mortality. The treatment effect, however, varied according to patients CRP concentrations at baseline.
Smit JM, Van Der Zee PA, Stoof SCM, Van Genderen ME, Snijders D, Boersma WG, Confalonieri P, Salton F, Confalonieri M, Shih MC, Meduri GU, Dequin PF, Le Gouge A, Lloyd M, Karunajeewa H, Bartminski G, Fernández-Serrano S, Suárez-Cuartín G, van Klaveren D, Briel M, Schönenberger CM, Steyerberg EW, Gommers DAMPJ, Bax HI, Bos WJW, van de Garde EMW, Wittermans E, Grutters JC, Blum CA, Christ-Crain M, Torres A, Motos A, Reinders MJT, Van Bommel J, Krijthe JH, Endeman H. Predicting benefit from adjuvant therapy with corticosteroids in community-acquired pneumonia: a data-driven analysis of randomised trials. Lancet Respir Med. 2025 Mar;13(3):221-233. doi: 10.1016/S2213-2600(24)00405-3. Epub 2025 Jan 29. PMID: 39892408.
