Steroid treatment may not improve mortality in community-acquired pneumonia, but it was associated with significantly shorter hospital stays and an increase in the chance of a clean chest radiograph after treatment.
A meta-analysis of eight studies on the topic showed that steroid treatment reduced the overall length of stay by a little over 1 day. There also was an 87% reduction in the risk of an abnormal chest x-ray at 1 week and an 88% reduction in the risk of delayed shock. These last findings, however, were based on just a few of the analysis’ studies, which were considered only of moderate quality, Dr. Majid Shafiq and colleagues wrote in the March issue of the Journal of Hospital Medicine.
Dr. Majid Shafiq
"The data are not strong enough to recommend routine use of steroids among all adults hospitalized with" community-acquired pneumonia (CAP), wrote Dr. Shafiq and his coauthors at the Mayo Clinic in Rochester, Minn. "However, considering that there was no increase in mortality or hospital length of stay with steroid use, it is reasonable to continue steroids if warranted for treatment of underlying comorbid conditions," they noted (J. Hosp. Med. 2013;8:68-75).
The analysis included a total of 1,119 patients, and there were four randomized controlled trials among the studies. In seven studies, the mean patient age ranged from 60 to 80 years. In one study, patients in the experimental arm were a mean of 32 years and those in the control arm were a mean of 41 years. Only one study used a chest x-ray score.
The mean length of stay in the intensive care unit was 13 days for patients taking steroids and 12 for the control patients. The mean hospital length of stay was 10 days for those taking steroids and 14 days for those who did not, said Dr. Shafiq, who is now with Johns Hopkins University, Baltimore, and his associates.
Steroid use did not significantly impact the length of ICU stay or mortality. Four studies showed significantly lower clinical cure rates and a higher number of late failures in patients taking steroids. Two showed no between-group differences in the occurrence of superinfections. Three studies reported that the drugs did not affect gylcemic levels, while four found more frequent hyperglycemia in the steroid group.
"Our study is the first to demonstrate decreased length of hospital stay in this patient population," the investigators wrote. "Importantly, each of the five studies that reported this outcome (including three relatively recent randomized controlled trials) showed the same trend. However, it is not inconceivable that steroid use led to a quicker decline in cytokine levels resulting in an earlier resolution of fever and hence earlier discharge without a faster cure per se."
Dr. Shafiq and his associates reported no financial conflicts.