Adjunctive Corticosteroids for Pneumocystis jirovecii Pneumonia in Non-HIV-infected Patients: A Systematic Review and Meta-analysis of Observational Studies.
BACKGROUND
The clinical benefits of adjunctive corticosteroids for Pneumocystis jirovecii (P. jirovecii) pneumonia in patients not infected with the human immunodeficiency virus (HIV) has not been evaluated by meta-analysis.


METHODS
We conducted a systematic review of published studies describing the effects of adjunctive corticosteroids on outcome in non-HIV P. jirovecii pneumonia patients. Two investigators independently searched the PubMed and Cochrane databases for eligible articles written in English. A meta-analysis was performed using a random-effects model for measuring mortality as the primary outcome, and the need for intubation or mechanical ventilation as the secondary outcome.


RESULTS
Seven observational studies were eligible. In these studies, adjunctive corticosteroids did not affect mortality in non-HIV patients (odds ratio [OR] 1.26; 95% CI 0.60-2.67) and there was no beneficial effect in patients with severe hypoxemia (PaO2<70mmHg) (OR 0.90; 95% CI 0.44-1.83). No significant effect on the secondary outcome was observed (OR 1.34; 95% CI 0.44-4.11).


CONCLUSIONS
Although the studies were observational, meta-analysis showed that adjunctive corticosteroids did not improve the outcome of P. jirovecii pneumonia in non-HIV patients. The results warrant a randomized controlled trial.
Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japón. Electronic address: fujikura@ndmc.ac.jp.
Yuji
Y
Fujikura
Department of Pulmonary Medicine, University of Tsukuba, Graduate School of Comprehensive Human Science, Ibaraki, Japón; Department of Hygiene and Public Health, Teikyo University, School of Medicine, Tokio, Japón.
Toshie
T
Manabe
Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japón.
Akihiko
A
Kawana
Nagasaki University, Nagasaki, Japón.
Shigeru
S
Kohno
D000293:Adolescent; D000328:Adult; D018023:HIV Seronegativity; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007121:Immunocompetence; D016867:Immunocompromised Host; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D064887:Observational Studies as Topic; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
Corticoides; Corticosteroids; Huésped inmunocomprometido; Immunocompromised host; Neumonía por Pneumocystis; Pneumocystis jirovecii; Pneumocystis pneumonia; Review; Revisión