Adjunctive Corticosteroids for Severe Community-Acquired Pneumonia

Brit Long; Michael Gottlieb

BRIT LONG, MD, Brooke Army Medical Center, Fort Sam Houston, Houston, Texas

MICHAEL GOTTLIEB, MD, Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois

Am Fam Physician. 2023;108(6):online

Author disclosure: No relevant financial relationships.

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Study Population: 1,689 adult patients with severe community-acquired pneumonia (CAP) from seven randomized controlled trials (RCTs) comparing adjunctive corticosteroids with placebo or standard care

Efficacy End Points: 30-day, all-cause mortality; requirement for mechanical ventilation; length of intensive care unit (ICU) stay; length of hospital stay

Harm End Points: Adverse events, including gastrointestinal bleeding, health care–associated infection, acute kidney injury, and hospital readmission

Benefits	Harms
1 in 16 had lower risk of 30-day, all-cause mortality	No harms; no significant difference reported for any adverse events (e.g., gastrointestinal bleeding, health care–associated infection, acute kidney injury, hospital readmission)
1 in 7 had lower risk of requiring mechanical ventilation
Reduced length of intensive care unit stay (mean difference = −0.8 day)
Reduced length of hospital stay (mean difference = −1.1 day)

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