title: Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Community-acquired pneumonia (CAP) is common and often severe.
  
  
  OBJECTIVE
  To examine the effect of adjunctive corticosteroid therapy on mortality, morbidity, and duration of hospitalization in patients with CAP.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through 24 May 2015.
  
  
  METHODS
  Randomized trials of systemic corticosteroids in hospitalized adults with CAP.
  
  
  METHODS
  Two reviewers independently extracted study data and assessed risk of bias. Quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation system by consensus among the authors.
  
  
  RESULTS
  The median age was typically in the 60s, and approximately 60% of patients were male. Adjunctive corticosteroids were associated with possible reductions in all-cause mortality (12 trials; 1974 patients; risk ratio [RR], 0.67 [95% CI, 0.45 to 1.01]; risk difference [RD], 2.8%; moderate certainty), need for mechanical ventilation (5 trials; 1060 patients; RR, 0.45 [CI, 0.26 to 0.79]; RD, 5.0%; moderate certainty), and the acute respiratory distress syndrome (4 trials; 945 patients; RR, 0.24 [CI, 0.10 to 0.56]; RD, 6.2%; moderate certainty). They also decreased time to clinical stability (5 trials; 1180 patients; mean difference, -1.22 days [CI, -2.08 to -0.35 days]; high certainty) and duration of hospitalization (6 trials; 1499 patients; mean difference, -1.00 day [CI, -1.79 to -0.21 days]; high certainty). Adjunctive corticosteroids increased frequency of hyperglycemia requiring treatment (6 trials; 1534 patients; RR, 1.49 [CI, 1.01 to 2.19]; RD, 3.5%; high certainty) but did not increase frequency of gastrointestinal hemorrhage.
  
  
  CONCLUSIONS
  There were few events and trials for many outcomes. Trials often excluded patients at high risk for adverse events.
  
  
  CONCLUSIONS
  For hospitalized adults with CAP, systemic corticosteroid therapy may reduce mortality by approximately 3%, need for mechanical ventilation by approximately 5%, and hospital stay by approximately 1 day.
  
  
  BACKGROUND
  None.
authors.forename: Reed A C
authors.initials: RA
authors.lastname: Siemieniuk
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
authors.forename: Matthias
authors.initials: M
authors.lastname: Briel
authors.forename: Nathan
authors.initials: N
authors.lastname: Evaniew
authors.forename: Manya
authors.initials: M
authors.lastname: Prasad
authors.forename: Paul E
authors.initials: PE
authors.lastname: Alexander
authors.forename: Yutong
authors.initials: Y
authors.lastname: Fei
authors.forename: Per O
authors.initials: PO
authors.lastname: Vandvik
authors.forename: Mark
authors.initials: M
authors.lastname: Loeb
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D017024:Chemotherapy, Adjuvant; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D003422:Critical Care; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones