The Systematic Review Of Corticosteroid Therapy In The Treatment Of Community Acquired Pneumonia In Adult

Object:Community-acquired pneumonia(CAP) is pneumonia acquired infectiously from normal social contact as opposed to being acquired during hospitalization. CAP is a leading cause of illness and death. This review aims to determine the efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia(CAP).Methods:This meta-analysis was followed the widely accepted methodological recommendations to search randomized clinical trials of glucocorticoid treatment of adults community-acquired pneumonia. Randomized clinical trials were identified through systematic searches. We searched randomized controlled trials from Pub Med, EMBASE,Cochrane Library,Ovid, Elisevier,Chinese Biomedical Literature Database, Chinese Journal Full-text Database,Wanfang database,CKNI and VIP with a cut-off date in December 2015.Search terms was Community acquired pneumonia, Corticosteroids,Steroids,Glucocorticoids,Dexamethasone,Hydrocortisone,Prednisone and methylprednisolone.13 randomized clinical trials were included in the systematic reviews. Methodological quality was evaluated using the Cochrane bias risk assessment tools. For the meta- analysis, outcome measures were assessed by Rev Man software version 5.3. For dichotomous outcomes,we compare outcome measures using the odds ratio(OR) with 95% confidence intervals(CI). For continuous outcomes, the means difference(MD) with 95% confidence intervals(CI) was used.After heterogeneity test,date without heterogeneity could be using fixed effect model.Those with heterogeneity could be using randomized effect model estimated. If meta- analysis can't be done, qualitative descriptions were made.Results:13 RCTs involving 2248 patients were included in the meta-analysis. No statistically significant differences were found in the mortality rate(OR=0.73, 95%CI 0.52–1.05, P=0.07).The mean length of hospital stay in glucocorticoids treatment group was significantly shorter than that in standard treatment group(WMD = –1.66, 95%CI-2.37–-0.94, Z=4.56, P<0.00001). Glucocorticoids treatment group has a lower rate of mechanical ventilation rates(OR=0.31,95%CI 0.19–0. 50, P<0.00001) and make more improvement in chest radiograph score rates(OR=10.46,95%CI 1.77–61. 83, P=0.01).Bu T The mean length of hospital stay in ICU(WMD=1.17,95%CI1.68–4.02, Z=0.81, P=0.42) was significantly shorter than that in standard treatment group.The incidence of upper gastrointestinal bleeding(OR=1.51, 95%CI 0.42–5.50, P=0.53),the incidence of super infection(OR=1.41, 95%CI 0.70–2.85, P=0.34),the incidence of hyperglycemia(OR=1.40, 95%CI 1.02– 1.94, P=0.04),between the standard treatment group and the glucocorticoids treatment group.Conclusion:The use of glucocorticoids in patients with community-acquired pneumonia can significantly shorten the duration of illness,reduce mechanical ventilation rates and improve chest radiograph score rates.It also have a favorable safety profile. However, it could not reduce the overall mortality and mean length of hospital stay at ICU.