(1455) Corticosteroids in Severe Community-Acquired Pneumonia: Meta-Analysis of Randomized Control Trials

Monday, January 22, 2024

10:15 AM – 11:15 AM MT

Location: Connections Central - RST 15

First Author(s)

AR

Ajai S. Rajabalan, MD, , FASN

Intensivist, Nephrologist
WellStar Kennestone Hospital
Marietta, Georgia

Co-Author(s)

SN

Shashank Nuguru, MD

Physician
Memorial Sloan Kettering Cancer Center, United States
VG

Vinod Govindasamy, MD

Physician
SRMC, India
RK

Rahul Kumar, MD, FACP

Physician
Yale School of Medicine, United States
SK

Sajin Karakattu, MD

Physician
Emory University, United States
TV

Thara Vidyasagaran, MD

Physician
Emory University, United States

Introduction: Community Acquired Pneumonia (CAP) is a leading cause of death from infection in the USA and in many other developed countries. Mortality in CAP is driven by interactions between bacterial burden, virulence factors, and host immune response. Using the anti-inflammatory and immunomodulatory properties of Corticosteroids (CS) has been a subject of debate and recent guidelines have recommended against its use due to a lack of good quality clinical evidence. We performed a meta-analysis of Randomized Controlled Trials (RCT) that evaluated outcomes of CAP in CS versus standard therapy.

Methods: We searched online databases (PUBMED, EMBASE and COCHRANE) for RCTs comparing corticosteroids and standard care for patients with CAP. 17 trials were identified that met the criteria and a systematic review and meta-analysis was performed using RevMan 5.3.4

Results: A total of 17 trials with 4637 patients reported mortality that was significantly lower with CS (RR 0.77 95% CI [0.6, 0.98] P = 0.03). Nine trials reported the need for mechanical ventilation which was significantly lower in the CS arm (RR 0.57 95% CI [0.43, 0.74] P< 0.0001). The incidence of hyperglycemia (RR 1.64 95% CI [1.28, 2.11] P = 0.0001) in the CS group was significantly higher, but the incidence of gastrointestinal bleeding (RR 1.18 95% CI [0.75, 1.86] P = 0.48) or infection (RR 1.04 95% CI [0.67, 1.62] P = 0.86) was no different in either group.

Conclusions: Our study showed an improvement in overall mortality and the need for mechanical ventilation in patients receiving corticosteroids. The lack of a higher incidence of GI bleed or infections in the CS group serves to assuage concerns regarding the safety profile of CS. Our study has some limitations – significant heterogeneity, non-standardization of steroid choice or dosing, or route or timing of administration. The need of the hour is a well-designed high-powered pragmatic RCT to evaluate outcomes in patients with CAP to help define future clinical guidelines.