title: Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Community-acquired pneumonia (CAP) induces lung and systemic inflammation, leading to high morbidity and mortality. We systematically reviewed the risks and benefits of adjunctive corticotherapy in the management of patients with CAP.
  
  
  METHODS
  We systematically searched Pubmed, Embase and the Cochrane Library for randomized controlled trials comparing adjunctive corticotherapy and antimicrobial therapy with antimicrobial therapy alone in patients with CAP. The primary outcome was 30-day mortality. Secondary outcomes were length of hospital stay, time to clinical stability and severe complications.
  
  
  RESULTS
  14 trials (2077 patients) were included. The reported 30-day mortality was 7.9% (80/1018) among patients treated with adjunctive corticotherapy versus 8.3% (85/1028) among patients treated with antimicrobial therapy alone (RR 0.84; 95%CI 0.55 to1.29). Adjunctive corticotherapy was associated with a reduction of severe complications (RR 0.36; 95%CI 0.23 to 0.56), a shorter length of stay (9.0 days; 95%CI 7.6 to 10.7 vs 10.6 days; 95%CI 7.4 to 15.3) and a shorter time to clinical stability (3.3 days; 95% CI 2.8 to 4.1 vs 4.3 days; 95%CI 3.6 to 5.1). The risk of hyperglycemia was higher among patients treated with adjunctive corticotherapy (RR 1.59; 95%CI 1.06 to 2.38), whereas the risk of gastro-intestinal bleeding was similar (RR 0.83; 95%CI 0.35 to 1.93). In the subgroup analysis based on CAP severity, a survival benefit was found among patients with severe CAP (RR 0.47; 95%CI 0.23 to 0.96).
  
  
  CONCLUSIONS
  Adjunctive corticotherapy is associated with a reduction of length of stay, time to clinical stability, and severe complications among patients with CAP, but the effect on mortality remains uncertain.
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Geneva, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Marti
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Geneva, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Grosgurin
authors.affiliation: Division of Infectious Diseases, Department of Medical Specialties, Geneva University Hospitals and Geneva Faculty of Medicine, Geneva, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.affiliation: Department of Health and Community Medicine, University Hospitals of Geneva and Geneva Faculty of Medicine, Geneva, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
authors.affiliation: Division of Infectious Diseases, Department of Medical Specialties, Geneva University Hospitals and Geneva Faculty of Medicine, Geneva, Switzerland.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abbas
authors.affiliation: Division of Emergency Medicine, Geneva University Hospitals and Geneva Faculty of Medicine, Geneva, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rutschmann
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Geneva, Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Geneva Faculty of Medicine, Geneva, Switzerland.|Division of Internal Medicine, Hôpital Riviera-Chablais, Monthey, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Garin
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000401:mortality; D007902:Length of Stay; D008297:Male; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality*; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones