PT  - JOURNAL ARTICLE
AU  - See, Xin Ya
AU  - Wang, Tsu Hsien
AU  - Chang, Yu-Cheng
AU  - Lo, Juien
AU  - Liu, Weitao
AU  - Choo, Cheryn Yu Wei
AU  - Lee, Yu-Che
AU  - Ma, Kevin Sheng Kai
AU  - Chiang, Cho-Hsien
AU  - Hsia, Yuan Ping
AU  - Chiang, Cho-Hung
AU  - Chiang, Cho-Han
TI  - Impact of different corticosteroids on severe community-acquired pneumonia: a systematic review and meta-analysis
AID  - 10.1136/bmjresp-2023-002141
DP  - 2024 Jan 01
TA  - BMJ Open Respiratory Research
PG  - e002141
VI  - 11
IP  - 1
4099  - http://bmjopenrespres.bmj.com/content/11/1/e002141.short
4100  - http://bmjopenrespres.bmj.com/content/11/1/e002141.full
SO  - BMJ Open Resp Res2024 Jan 01; 11
AB  - Objectives Randomised controlled trials (RCTs) have demonstrated conflicting results regarding the effects of corticosteroids on the treatment of severe community-acquired pneumonia (CAP). We aimed to investigate the efficacy and safety of different corticosteroids on patients who were hospitalised for severe CAP.Methods We performed a systematic search through PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to May 2023. The primary outcome was all-cause mortality. Data analysis was performed using a random-effects model.Results A total of 10 RCTs comprising 1962 patients were included. Corticosteroids were associated with a lower rate of all-cause mortality (risk ratio (RR), 0.70 (95% CI 0.54 to 0.90); I2=0.00%). When stratified into different corticosteroid types, hydrocortisone was associated with an approximately 50% lower mortality risk (RR, 0.48 (95% CI 0.32 to 0.72); I2=0.00%). However, dexamethasone, methylprednisolone or prednisolone were not associated with an improvement in mortality. Furthermore, hydrocortisone was associated with a reduction in the rate of mechanical ventilation, acute respiratory distress syndrome, shock and duration of intensive care unit stay. These trends were not observed for dexamethasone, methylprednisolone or prednisolone. Corticosteroids were not associated with an increased risk of adverse events including gastrointestinal bleeding, secondary infection or hyperglycaemia.Conclusions The use of hydrocortisone, but not other types of corticosteroids, was associated with a reduction in mortality and improvement in pneumonia outcomes among patients hospitalised with severe CAP.PROSPERO registration numberCRD42023431360.Data are available upon reasonable request. The authors confirm that the data supporting the findings of this study are available within the article or its supplementary materials. The template data collection forms and data used for all analyses including the analytic code can be obtained upon reasonable request from the corresponding author.