Table 2. Meta-analysis evaluating the effect of corticosteroids in pneumonia.
| Author (y) | N | Disease | Corticosteroid (dosage) | Duration of treatment (d) | Outcomes evaluated | Results | Side effects |
|---|---|---|---|---|---|---|---|
| Chen et al (2011)31 | 6 RCTs (n = 437) | CAP | Confalonieri et al25: hydrocortisone (240 mg/d) | 7 | Mortality Time to resolution, relapse of pneumonia, need of MV or inotropic support, admission to ICU, time to discharge from ICU |
No significant differences Faster resolution of symptoms and time to clinical stability in the corticoid group |
Hyperglycemia |
| Marik et al61: hydrocortisone (10 mg/kg/d) | 1 | ||||||
| McHardy and Schonell62: prednisolone (20 mg/d) | 7 | ||||||
| Mikami et al63: prednisolone (40 mg/d) | 3 | ||||||
| Van Woensel et al64: dexamethasone (0.15 mg/kg/6 h) | 1 | ||||||
| Cao et al65: budesonide (250–500 g/d) | 7 | ||||||
| Nie et al (2012)32 | 9 RCTs (n = 1,001) | CAP of any severity | Wagner et al66: hydrocortisone (560 mg) | 5 | Mortality Adverse events |
No significant differences Significant survival benefit in the subgroup of severe CAP More hyperglycemia events in the corticosteroids group |
Hyperglycemia |
| McHardy and Schonell62: prednisolone (20 mg/d) | 7 | ||||||
| Marik et al61: hydrocortisone (10 mg/kg) | 1 | ||||||
| Confalonieri et al25: hydrocortisone (240 mg/d) | 7 | ||||||
| Mikami et al63: prednisolone (40 mg/d) | 3 | ||||||
| Snijders26: prednisolone (40 mg/d) | 7 | ||||||
| Meijvis et al27: dexamethasone (5 mg/d) | 4 | ||||||
| Sabry and Omar 67: hydrocortisone (300 mg/d) | 7 | ||||||
| Fernández-Serrano et al28: methylprednisolone (620 mg/d) | 9a | ||||||
| Marti et al (2015)33 | 13 RCTs (n = 2,077) | CAP of any severity | Included 9 RCTs of Nie et al32 and: | 30-d mortality Length of stay, time to clinical stability, need of MV or vasopressors, severe complications |
No significant differences Significant survival benefit in the subgroup of severe CAP Reduction of severe complications, shorter length of stay and shorter time to stability in the corticosteroid group |
Hyperglycemia | |
| Bennett et al68: hydrocortisone (300 mg/d) | 6 | ||||||
| Blum et al30: prednisone (50 mg/d) | 7 | ||||||
| Klastersky et al69: betamethasone (1 mg/kg/d) | 3 | ||||||
| Nafae et al70: hydrocortisone (200 mg + 10 mg/h) | 7 | ||||||
| Torres et al29: methylprednisolone (1 mg/kg) | 5 | ||||||
| Siemieniuk et al (2015)35 | 13 RCTs (n = 2,005) | CAP of any severity | Included the 9 RCTs: Nie et al32 + Blum et al,30 Nafae et al,70 and Torres et al29 | 7 | All-cause mortality Need of MV, ICU admission, risk for ARDS, length of stay, time to clinical stability, adverse effects |
No significant differences Significant survival benefit in the subgroup of severe CAP Significant reduction of MV, decreased time to clinical stability and length of stay in the corticosteroid group |
Hyperglycemia requiring treatment |
| In addition to: El-Ghamrawy et al71: hydrocortisone (200 mg bolus followed by 10 mg/h) |
|||||||
| Wan et al (2016)34 | 9 RCTs (n = 1,667) 6 cohort studies (n = 4,095) |
RCT: CAP of any severity Cohort studies: Severe CAP |
RCT
Marik et al61: hydrocortisone (10 mg/kg/d) |
1 | Mortality | No significant differences | No significant differences |
| Confalonieri et al25: hydrocortisone (200 mg bolus followed by 10 mg/h) | 7 | ||||||
| Mikami et al63: prednisolone (40 mg/d) Snijders et al26: prednisolone (40 mg/d) Fernández-Serrano et al28: methylprednisolone (620 mg/d) Meijvis et al27: dexamethasone (5 mg/d) |
3 7 9a 4 7 |
||||||
| Nafae et al70: hydrocortisone (200 mg + 10 mg/h) | 7 | ||||||
| Blum et al30: prednisone (50 mg/d) | 5 | ||||||
| Torres et al29: methylprednisolone (1 mg/kg) | 11 | ||||||
| Cohort studies | |||||||
| Garcia-Vidal et al22: methylprednisolone (24 mg/d)/prednisone (30 mg/d) | 7 | ||||||
| Salluh et al23: equivalent methylprednisolone (60 mg/d) | 4–7 | ||||||
| Chon et al72: NA | 7 | ||||||
| Ugajin et al73: methylprednisolone, prednisolone, or dexamethasone (20–60 mg/d) | 7 | ||||||
| Polverino et al74: methylprednisolone P (0.5–2.5 mg/kg/d or equivalent dose) Tagami et al24: methylprednisolone P (0.5–2.5 mg/kg/d or equivalent dose) |
Abbreviations: ARDS, acute respiratory distress syndrome; ICU, intensive care unit; MV, mechanical ventilation; N, number of patients; NA, not available; RCT, randomized controlled trials.
a
Gradual withdrawal.