title: Corticosteroid therapy for severe community-acquired pneumonia: a meta-analysis.
abstract: BACKGROUND
  The debate about the efficacy of corticosteroids in the treatment of severe community-acquired pneumonia (CAP) is still a longstanding dilemma. We performed a meta-analysis including 4 randomized controlled trials (RCTs) to evaluate the effect of corticosteroids on the treatment of severe CAP in adults.
  
  
  METHODS
  We performed a systematic review of published and unpublished clinical trials. Databases, including PubMed, Embase, CINAHL, and Cochrane (from their establishment to July 2013), were searched for relevant articles. Only RCTs of corticosteroids as adjunctive therapy in adult patients with severe CAP were selected.
  
  
  RESULTS
  Four trials enrolling 264 patients with severe CAP were included. Use of corticosteroids significantly reduced hospital mortality compared with conventional therapy and placebo (Peto odds ratio = 0.39, 95% CI 0.17-0.90). The quality of the evidence underlying the pooled estimate of effect on hospital mortality was low, downgraded for inconsistency and imprecision.
  
  
  CONCLUSIONS
  On the basis of the current limited evidence, we suggest that, although corticosteroid therapy may reduce mortality and improve the prognosis of adult patients with severe CAP, the results should be interpreted with caution due to the instability of pooled estimates. Reliable treatment recommendations will be raised only when large sufficiently powered multi-center RCTs are conducted.
authors.affiliation: Department of Pneumology.
authors.forename: Ming
authors.initials: M
authors.lastname: Cheng
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Pan
authors.forename: Jiong
authors.initials: J
authors.lastname: Yang
authors.forename: Ya-Dong
authors.initials: YD
authors.lastname: Gao
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones
keywords: corticosteroids; meta-analysis; mortality; severe cap