PT  - JOURNAL ARTICLE
AU  - Ming Cheng
AU  - Zhi-yong Pan
AU  - Jiong Yang
AU  - Ya-dong Gao
TI  - Corticosteroid therapy for severe community-acquired pneumonia: A meta-analysis
AID  - 10.4187/respcare.02758
DP  - 2013 Sep 17
TA  - Respiratory Care
PG  - respcare.02758
4099  - http://rc.rcjournal.com/content/early/2013/09/17/respcare.02758.short
4100  - http://rc.rcjournal.com/content/early/2013/09/17/respcare.02758.full
AB  - Background The debate about the efficacy of corticosteroids in the treatment of severe community-acquired pneumonia (CAP) is still a long-standing dilemma. We did a meta-analysis including four randomized controlled trials (RCTs) to evaluate the effect of corticosteroids on the treatment of severe CAP of adults. Methods We performed a systematic review of published and unpublished clinical trails. Databases including PubMed, CENTRAI, CINAHL and Cochrane (from their establishment to July 2013) were searched for relevant literatures. Only RCTs of corticosteroids as adjunctive therapy in adult patients with severe CAP were selected. Results Four trails enrolling 264 severe CAP patients were included. Use of corticosteroids significantly reduced hospital mortality compared with conventional therapy and placebo (Peto OR=0.39; 95% CI, 0.17-0.90). The quality of the evidence underlying the pooled estimate of effect on hospital mortality was low, downgraded for inconsistency and imprecision. Conclusions Based on the current limited evidence, we suggest that, although corticosteroid therapy may reduce mortality and improve the prognosis of adult patients with severe CAP, the results should be interpreted with caution due to the instability of pooled estimates. Reliable treatment recommendations will be raised only when large sufficiently powered multicenter RCTs are conducted.