title: Efficacy and Safety of Adjunctive Corticosteroids Therapy for Severe Community-Acquired Pneumonia in Adults: An Updated Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Adjunctive corticosteroids therapy is an attractive option for community-acquired pneumonia (CAP) treatment. However, the effectiveness of adjunctive corticosteroids on mortality of CAP remains inconsistent, especially in severe CAP. We performed a meta-analysis to evaluate the efficacy and safety of adjunctive corticosteroids in severe CAP patients.
  
  
  METHODS
  Three databases of PubMed, EMBASE and Cochrane Library were searched for related studies published in English up to December, 2015. Randomized controlled trials (RCTs) of corticosteroids in hospitalized adults with severe CAP were included. Meta-analysis was performed by a random-effect model with STATA 11.0 software. We estimated the summary risk ratios (RRs) or effect size (ES) with its corresponding 95% confidence interval (95%CI) to assess the outcomes.
  
  
  RESULTS
  We included 8 RCTs enrolling 528 severe CAP patients. Adjunctive corticosteroids significantly reduced all-cause mortality (RR = 0.46, 95%CI: 0.28 to 0.77, p = 0.003), risk of adult respiratory distress syndrome (ARDS) (RR = 0.23, 95%CI: 0.07 to 0.80, p = 0.02) and need for mechanical ventilation (RR = 0.50, 95%CI: 0.27 to 0.92, p = 0.026). Adjunctive corticosteroids did not increase frequency of hyperglycemia requiring treatment (RR = 1.03, 95%CI: 0.61 to 1.72, p = 0.91) or gastrointestinal hemorrhage (RR = 0.66, 95%CI: 0.19 to 2.31, p = 0.52). In subgroup analysis by duration of corticosteroids, we found that prolonged corticosteroids therapy significantly reduced all-cause mortality (RR = 0.41, 95%CI: 0.20 to 0.83, p = 0.01) and length of hospital stay (-4.76 days, 95% CI:-8.13 to -1.40, p = 0.006).
  
  
  CONCLUSIONS
  Results from this meta-analysis suggested that adjunctive corticosteroids therapy was safe and beneficial for severe CAP. In addition, prolonged corticosteroids therapy was more effective. These results should be confirmed by adequately powered studies in the future.
authors.affiliation: Department of Respiratory Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Jirui
authors.initials: J
authors.lastname: Bi
authors.affiliation: Department of Respiratory Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Respiratory Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: School of Public Health, Anhui Medical University, Hefei, China.
authors.forename: Cijiang
authors.initials: C
authors.lastname: Yao
authors.affiliation: Department of Respiratory Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Mei
authors.affiliation: School of Public Health, Anhui Medical University, Hefei, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: The Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, China.
authors.forename: Jiyu
authors.initials: J
authors.lastname: Cao
authors.affiliation: Department of Respiratory Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
authors.forename: Youjin
authors.initials: Y
authors.lastname: Lu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D003131:Combined Modality Therapy; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007902:Length of Stay; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones