Corticosteroids shorten hospital stay for community-acquired pneumonia

Adjunct treatment with corticosteroids reduced hospital stays for patients with community-acquired pneumonia, or CAP, study data showed.

“An excessive inflammatory cytokine response could be a major contributor to the high mortality rate in CAP,” Matthias Briel, MD, MSc, assistant professor at Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel, Switzerland, and colleagues wrote. “Corticosteroids naturally down-regulate proinflammatory cytokine production. Systemic corticoid therapy attenuates the inflammatory response, and by doing so may decrease the frequency of acute respiratory distress syndrome, reduce the length of illness and hospital stay and reduce mortality.”

Briel and colleagues reviewed the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trial databases for randomized controlled trials comparing low-dose oral or IV corticosteroids with placebo as adjunct therapy for CAP. The researchers ultimately reviewed data from six trials of 1,506 patients.

Thirty-seven of 748 patients (5%) assigned to corticosteroids died within 30 days, Briel and colleagues reported, compared with 45 of 758 patients (5.9%) in the placebo group (adjusted OR = 0.75; 95% CI, 0.46-1.21). Those who received corticosteroids experienced a shorter time to clinical stability (–1.03 days; 95% CI, –1.62 to –0.43; P = .001) and shortened hospital stay (–1.15 days; 95% CI, –1.75 to –0.55; P < .001), the researchers wrote.

However, more patients who were assigned to corticosteroids experienced hyperglycemia that required insulin treatment (n = 160; 22.1% vs 12%; aOR = 2.15; 95% CI, 1.6-2.9), Briel and colleagues reported. Further, more patients assigned to corticosteroids had to be re-hospitalized from causes related to CAP (5% vs. 2.7%; aOR = 1.85; 95% CI, 1.03-3.32). The researchers reported that they did not find any significant effect modification by degree of inflammation or severity of pneumonia.

“Adjunctive corticosteroids reduce the time to clinical stability from approximately 4 to 3 days and in [length of stay] from 8 to 7 days,” they wrote. “Given that the total cost of CAP is over 10 billion euros per year in Europe, much of which is related to in-hospital care, a reduction in [length of stay] by 12.5% would have considerable economic impact.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.