Corticosteroids benefit community-acquired pneumonia

the Clinical Advisor take:

Corticosteroids decrease treatment failure in patients with severe, community-acquired pneumonia and a high inflammatory response, according to a study published in JAMA.

Among patients with severe, community-acquired pneumonia, treatment failure is associated with poorer outcomes. The researchers in this study wanted to determine if corticosteroids could reduce treatment failure by modulating cytokine releases.

The study included 120 patients with both severe community-acquired pneumonia and a high inflammatory response from 3 different hospitals. Patients were considered to have a high inflammatory response if they had a level of C-reactive protein >150 mg/L at admission. The patients were randomized to receive either an intravenous bolus of methylprednisolone (0.5 mg/kg per 12 hours) or a placebo. Treatment began within 36 hours of hospital admission and lasted for 5 days.

The researchers monitored the patients for both treatment failure, composite outcome of late treatment failure, and in-hospital mortality. Treatment failure was defined as development of shock, need for ventilation, or death within 72 hours of treatment initiation. Composite outcome of late treatment failure was defined as radiographic progression, persistence of severe respiratory failure, development of shock, need for ventilation, or death between 72 and 120 hours after treatment initiation.

In the patients treated with methylprednisolone, 13% experienced treatment failure compared with 31% of the placebo group. There was no significant difference between in-hospital mortality between the two groups.

Corticosteroids benefit community-acquired pneumonia
Corticosteroids benefit community-acquired pneumonia

Objective  To assess the effect of corticosteroids in patients with severe community-acquired pneumonia and high associated inflammatory response.

Results  There was less treatment failure among patients from the methylprednisolone group (8 patients [13%]) compared with the placebo group (18 patients [31%]) (P = .02), with a difference between groups of 18% (95% CI, 3% to 32%). Corticosteroid treatment reduced the risk of treatment failure (odds ratio, 0.34 [95% CI, 0.14 to 0.87]; P = .02). In-hospital mortality did not differ between the 2 groups (6 patients [10%] in the methylprednisolone group vs 9 patients [15%] in the placebo group; P = .37); the difference between groups was 5% (95% CI, −6% to 17%). Hyperglycemia occurred in 11 patients (18%) in the methylprednisolone group and in 7 patients (12%) in the placebo group (P = .34).

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