Glucocorticoids May Reduce Mortality for Community-Acquired Pneumonia
Glucocorticoid use for severe community-acquired pneumonia has been controversial due to the safety profile of these drugs.
Glucocorticoids have the potential to reduce mortality for patients with severe community-acquired pneumonia (CAP), but the effects could vary based on type and dosing, according to results of a study published in European Journal of Medical Research. However, there has been controversy surrounding the clinical use in practice of these drugs due to the safety profile.1,2
Glucocorticoid use for severe community-acquired pneumonia has been controversial due to the safety profile of these drugs. | Image Credit: Andrii - stock.adobe.com
In a previous study published in the European Respiratory Review, the study authors state that glucocorticoids “exhibit potent anti-inflammatory and immunomodulatory properties, potentially mitigating the impact of pneumonia.” The overall effect of these drugs remains unknown, and current guidelines recommend their use only for cases of severe CAP associated with septic shock. The long-term use of glucocorticoids has been well-established, but the shorter use remains not well understood, according to the authors. Therefore, glucocorticoids are avoided during infections due to safety concerns.2
Glucocorticoids can have a wide range of adverse effects (AEs), which can include musculoskeletal, metabolic and endocrine, cardiovascular, dermatologic, gastrointestinal, ophthalmologic, and neuropsychiatric effects, and infection. Dosing and duration are the most well-documented and independent risk factors of AEs.3
In the current study, investigators gathered literature from PubMed, Cochrane Library, Web of Science, EMBASE, and other databases from inception to April 29, 2023, and only randomized control trials were included in the study. Patients included had a clinical diagnosis of CAP. The primary outcome included mortality rate, and secondary outcomes included duration of mechanical ventilation, duration of no mechanical ventilation at 28 days, proportion of mechanical ventilation at day 8, length of hospital and intensive care unit (ICU) stay, and occurrence of adverse events (AEs).1
In the meta-analysis, investigators included a total of 8 randomized controlled trials, with 4 having a low risk of bias, 3 having unclear risk of bias in the randomization process, and 1 having unclear risk of bias in measurement outcomes. Compared to the control group, patients receiving glucocorticoids had a lower risk of mortality. When adjusting for potential publication bias, investigators confirmed the results.
As for secondary outcomes, 3 studies reported on the duration of mechanical ventilation, showing that there was a statistical difference between the duration of mechanical ventilation for adjuvant glucocorticoids and the standard of care. Additionally, 3 studies reported on mechanical ventilation on day 8, but there was not a statistical difference between the groups. Four studies reported on the length of hospital stay, showing there were no statistical differences in the length of stay for both groups. As for ICU stay, there was a statistically significant difference for patients receiving glucocorticoids or the standard of care alone.1
Four trials reported hyperglycemia, with an increase of new events at 37.5% compared with 29.6% for the standard of care. Further, there was no increase in gastrointestinal bleeding for 7 trials and no increased risk of secondary infection in 4 trials.1
“Our results suggest that the use of glucocorticoids can reduce the risk of death and the need for mechanical ventilation in patients with severe community-acquired pneumonia,” the authors concluded.1 “Glucocorticoids do not increase the risk of gastrointestinal bleeding or serious infection. However, they can increase the incidence of hyperglycemia in patients.”
