Dexamethasone reduces length of stay, ICU admission in patients with pneumonia

Oral dexamethasone reduced length of stay and ICU admissions in adults with community-acquired pneumonia, according to research presented at the virtual European Respiratory Society International Congress.

“Several studies have shown that corticosteroids can reduce length of hospital stay. However, most studies have investigated IV corticosteroids and it still remains unclear for what patients benefit most from corticosteroid treatments,” Esther Wittermans, MD, of the department of medical microbiology and immunology at St. Antonius Hospital, Nieuwegein, the Netherlands, said during her presentation. “Therefore, the objective of the study was to investigate the effect of a short course of oral dexamethasone on length of stay and to assess whether effect of dexamethasone is disease severity dependent.”

The multicenter, randomized, double-blind, placebo-controlled trial enrolled 401 adults with community-acquired pneumonia from December 2012 to November 2018. Patients were randomly assigned to receive once-daily oral dexamethasone 6 mg (n = 203) or placebo (n = 198) for 4 days.

Randomization was stratified by severity of the disease; mild pneumonia was defined by a pneumonia severity index of 1 through 3 and severe pneumonia was defined by a pneumonia severity index of 4 or 5.

Primary outcome was overall length of hospital stay. Secondary outcomes included number of ICU admissions following initial general ward admission and all-cause 30-day mortality.

Median length of stay was shorter in those assigned oral dexamethasone compared with those assigned placebo (4.5 days vs. 5 days; P = .03). The researchers reported no significant differences in length of stay between community-acquired pneumonia severity subgroups.

Those treated with dexamethasone had a lower rate of ICU admissions compared with placebo (3% vs. 7%; RR = 0.35; 95% CI, 0.13-0.95; P = .03).

Hospital readmission was higher in the dexamethasone group compared with placebo (10% vs. 5%; P = .07). Patients in the dexamethasone group had a higher prevalence of hyperglycemia (7% vs. 1%; P = .001).

Researchers observed no difference between 30-day mortality in all treatment groups (2% vs. 4%; RR = 0.56; 95% CI, 0.17-1.87; P = .34).

“In conclusion, oral dexamethasone reduced the length of stay by half a day in patients with community-acquired pneumonia and also reduced the number of ICU admissions,” Wittermans said. “However, it still remains unclear for which patients the risk-benefit ratio is optimal.”