Glucocorticoids can reduce mortality in patients with Severe community-acquired pneumonia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Gu Xue , Yang Penglei , Yu Lina , Yuan Jun , Zhang Ying , Yuan Zhou , Chen Lianxin , Zhang Xiaoli , Chen Qihong 
Published: November 2023

Background
Severe community-acquired pneumonia (sCAP) is associated with higher morbidity and mortality. The use of glucocorticoids to improve the prognosis of severe community-acquired pneumonia remains a topic of controversy.
Methods
Following the guidelines given in the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), we conducted a systematic review and meta-analysis to evaluate the effects of glucocorticoids on mortality and duration of mechanical ventilation in patients with sCAP. Randomized controlled studies investigating the use of glucocorticoids in the treatment of sCAP were extracted from PubMed, Embase, Cochrane Library, and Web of Science. Statistical analysis was performed to compare the differences in in-hospital mortality, mechanical ventilation duration, gastrointestinal bleeding, secondary infection, and other outcome measures between the glucocorticoid group and the control group.
Results
A total of 7 studies involving 1628 patients were included in the analysis. The hospital mortality in the glucocorticoid group was significantly lower than that in the control group [7 studies, relative risk (RR) 0.49; 95% CI, 0.27–0.89, p = 0.02. I 2 = 58%, moderate certainty]. The duration of mechanical ventilation in the glucocorticoid group was significantly shorter than that in the control group [Mean Difference(MD) -5.56;95% CI, -7.99– -3.13, p < 0.00001; I 2 = 45%, high certainty]. There was no significant difference in the incidence of gastrointestinal bleeding (RR 0.90;95% CI, 0.51–1.59, p = 0.72, I2 = 0%, high certainty) or secondary infection (RR 0.97;95% CI, 0.66–1.40, p = 0.85, I2 = 33%, high certainty) between the glucocorticoid group and the control group. In subgroup analysis, mortality was significantly lower in the hydrocortisone group compared to the control group (6.0% vs. 14.0%, RR 0.42;95%CI, 0.28–0.62, p < 0.0001, I2 = 0%, high certainty). However, there was no significant difference in mortality between the methylprednone group and the control group (10.7% vs. 10.0%, RR 0.89;95%CI, 0.34–2.33, P = 0.82, I2 = 53%, moderate certainty). There was a significant difference in mortality among 192 patients treated with glucocorticoid non-tapering compared to 156 patients treated with standard care (5.2% vs. 18.6%, RR 0.27;95%CI, 0.13–0.53, p = 0.0002, I 2 = 0%). However, there was no significant difference in mortality among 643 patients treated with glucocorticoid tapering compared to 637 patients treated with standard care (8.4% vs. 11.0%, RR 0.81;95%CI, 0.34–1.89, p = 0.62, I 2 = 83%).
Conclusion
Glucocorticoids can reduce mortality in patients with sCAP, and the effect may vary depending on the type of glucocorticoids used and whether the glucocorticoids are tapered or not.Additionally, glucocorticoid treatment can lead to a shorter duration of mechanical ventilation without increasing the risk of gastrointestinal bleeding or secondary infection in patients with sCAP.
PROSPERO registration: CRD42023416525