title: Systemic corticosteroids for community-acquired pneumonia: reasons for use and lack of benefit on outcome.
abstract: OBJECTIVE
  Although the benefits of systemic corticosteroids in community-acquired pneumonia (CAP) are not clear, their use is frequent in clinical practice. We described the frequency of this practice, patients' characteristics and its clinical impact.
  
  
  METHODS
  We investigated all adult CAP patients visited between June 1997 and January 2008 (n = 3257).
  
  
  RESULTS
  Two hundred and sixty patients received systemic corticosteroids (8%) with a mean daily dose of 45 (33) mg (median, 36 mg/day). Patients receiving corticosteroids were older (74 (13) vs 65 (19) years), had more comorbidities (respiratory, 59% vs 38%, cardiac, 29% vs 16%, etc.), higher Pneumonia Severity Index (Fine IV-V, 76% vs 50%) and had received inhaled corticosteroids (36% vs 15%) and previous antibiotics (31% vs 23%) more frequently (P < 0.01, each). Significant predictors of corticosteroid administration were: chronic obstructive pulmonary disease (odds ratio (OR), 1.91), fever (OR, 0.59), expectoration (OR, 1.59), creatinine (+1 mg/dL, OR, 0.92), SaO(2) ≥ 92% (OR, 0.46), C-reactive protein (+5 mg/dL; OR, 0.92) and cardiac failure (OR, 1.76). Mortality (6% vs 7%; P = 0.43) and time to clinical stability (4 (3-6) vs 5 (3-7) days; P = 0.11) did not differ between the two groups, while length of hospital stay was longer for the steroid group (9 (6-14) vs 6 (3-9) days; P < 0.01).
  
  
  CONCLUSIONS
  The main reasons for administering systemic steroids were the presence of chronic respiratory comorbidity or severe clinical presentation, but therapy did not influence mortality or clinical stability; by contrast, steroid administration was associated with prolonged length of stay. Nevertheless the steroid group did not show an increased mortality as it was expected according to the initial Pneumonia Severity Index score. Influence of steroids on outcomes of CAP need to be further investigated through randomized clinical trial.
authors.affiliation: Respiratory Disease Department, Hospital Clínic i Provincial de Barcelona, IDIBAPS, CIBER de Enfermedades Respiratorias, Barcelona,Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Polverino
authors.forename: Catia
authors.initials: C
authors.lastname: Cillóniz
authors.forename: Povilas
authors.initials: P
authors.lastname: Dambrava
authors.forename: Albert
authors.initials: A
authors.lastname: Gabarrús
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.forename: Carlos
authors.initials: C
authors.lastname: Agustí
authors.forename: Elena
authors.initials: E
authors.lastname: Prina
authors.forename: Beatriz
authors.initials: B
authors.lastname: Montull
authors.forename: Rosario
authors.initials: R
authors.lastname: Menendez
authors.forename: Michael S
authors.initials: MS
authors.lastname: Niederman
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones