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

Summary

Across 30 RCTs (n=7519), corticosteroids probably reduce short-term mortality and clearly reduce the need for invasive mechanical ventilation in hospitalized non-viral CAP, with possible reductions in ICU and hospital length of stay. Hyperglycemia requiring treatment increases, without a detectable rise in secondary infections.

Key Findings

• 30 RCTs including 7519 patients; prednisone-equivalent doses ranged 29–100 mg/day.
• Short-term (28–30 days) mortality reduced: RR 0.82 (95% CI 0.74–0.91; moderate certainty).
• Need for invasive mechanical ventilation reduced: RR 0.63 (95% CI 0.48–0.82; high certainty).
• ICU stay reduced by 1.53 days (95% CI 0.31–2.75 fewer; low certainty) and hospital stay by 2.30 days (95% CI 0.81–3.81 fewer; low certainty).
• Hyperglycemia requiring intervention increased: RR 1.32 (95% CI 1.12–1.56); no effect on secondary infections: RR 0.97 (95% CI 0.85–1.11).

Clinical Implications

Consider corticosteroids for hospitalized adults with non-viral CAP to reduce short-term mortality and invasive ventilation, while monitoring for hyperglycemia. Findings may standardize practice where recommendations have been inconsistent.

Limitations

• Heterogeneity in corticosteroid types, doses, and patient populations across RCTs.
• Lower certainty for longer-term mortality and for length-of-stay outcomes; potential publication bias cannot be excluded.

Future Directions

Define optimal dosing/duration, identify subgroups most likely to benefit, and integrate glucose management protocols to mitigate hyperglycemia.