Impact of different corticosteroids on severe community-acquired pneumonia: a systematic review and meta-analysis.

Autor:	See XY; Department of Medicine, Unity Hospital, Rochester Regional Health, Rochester, New York, USA., Wang TH; Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City, Taiwan., Chang YC; Department of Medicine, Danbury Hospital, Danbury, Connecticut, USA., Lo J; Department of Medicine, University of California San Diego, San Diego, California, USA., Liu W; Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA., Choo CYW; Department of Internal Medicine, Singapore Health Services, Singapore., Lee YC; Division of Pulmonary, Critical Care and Sleep Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA., Ma KSK; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Chiang CH; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan., Hsia YP; Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City, Taiwan ustwhealth.datascience.group@gmail.com., Chiang CH; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan., Chiang CH; Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	BMJ open respiratory research [BMJ Open Respir Res] 2024 Jan 22; Vol. 11 (1). Date of Electronic Publication: 2024 Jan 22.
DOI:	10.1136/bmjresp-2023-002141
Abstrakt:	Objectives: Randomised controlled trials (RCTs) have demonstrated conflicting results regarding the effects of corticosteroids on the treatment of severe community-acquired pneumonia (CAP). We aimed to investigate the efficacy and safety of different corticosteroids on patients who were hospitalised for severe CAP. Methods: We performed a systematic search through PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to May 2023. The primary outcome was all-cause mortality. Data analysis was performed using a random-effects model. Results: A total of 10 RCTs comprising 1962 patients were included. Corticosteroids were associated with a lower rate of all-cause mortality (risk ratio (RR), 0.70 (95% CI 0.54 to 0.90); I 2 =0.00%). When stratified into different corticosteroid types, hydrocortisone was associated with an approximately 50% lower mortality risk (RR, 0.48 (95% CI 0.32 to 0.72); I 2 =0.00%). However, dexamethasone, methylprednisolone or prednisolone were not associated with an improvement in mortality. Furthermore, hydrocortisone was associated with a reduction in the rate of mechanical ventilation, acute respiratory distress syndrome, shock and duration of intensive care unit stay. These trends were not observed for dexamethasone, methylprednisolone or prednisolone. Corticosteroids were not associated with an increased risk of adverse events including gastrointestinal bleeding, secondary infection or hyperglycaemia. Conclusions: The use of hydrocortisone, but not other types of corticosteroids, was associated with a reduction in mortality and improvement in pneumonia outcomes among patients hospitalised with severe CAP.PROSPERO registration numberCRD42023431360. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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