Effects Of Corticosteroids On Severe Community-acquired Pneumonia: A Meta-analysis

Background: Pneumonia, which can be classified to community-acquired pneumonia(CAP) and hospital-acquired pneumonia(HAP), is one of the most prevalent respiratory diseases. In general population, the incidence of CAP was approximately 2‰to 12‰ and the majority can be cured in out-patients clinic. Only 20% of CAP patients require hospitalization. The mortality of hospitalized CAP patients was 10% to 25%,and even higher than 50% if they were transferred to intensive care unit(ICU) with severe pneumonia. Severe pneumonia is one of the top 10 deadly diseases for its high prevalence and mortality. Antibiotic resistance was once believed to be mainly responsible for the curative effect and prognosis of severe pneumonia until later studies showed that infection pathogenic bacteria of severe CAP death patients were sensitive to most antibiotics. In terms of pathophysiology of severe pneumonia, researchers tended to believe that acute systemic inflammatory response syndrome(SIRS) may be responsible for progression to multiple organ failure(MOF) and death in severe pneumonia patients.Thereafter, studies began to focus on modulating the inflammatory response after pathogen invasion to evaluate the therapeutic effect of severe pneumonia. As a potent anti-inflammatory agent, extensive attention was give to assess the curative effect of glucocorticoid to severe pneumonia. However, confounding conclusions of many clinical trails makes this topic controversial. In the last two decades, evidence-based medicine(EBM) was given unprecedented attention and had been widely used in developed countries. Named after one late epidemiologist, a Cochrane Centre was established in London in 1992, aiming to collect randomized controlled trials in all fields throughout the world to conduct meta analysis of these data, so as to provide the best evidence for clinicians for their clinical decision-making.Objective: To systematically evaluate the effect of glucocorticoid on severe community-acquired pneumonia.Methods: Randomized controlled trial(RCTs) on the effects of glucocorticoid on patients with severe pneumonia were identified from the following databases: CBM,weipu, wangfang, CNKI, pubmed, Embase and Cochrane Library from their initial to March, 2015. The keywords were Steroids, Glucocorticoids, Adrenal Cortex Hormones,hydrocortisone, cortisone, prednisone, methylprednisolone, dexamethasone,community-acquired pneumonia, severe community-acquired pneumonia, severe pneumonia 、 pneumonia, randomized controlled trials, randomized. Only RCTs were included, and Revman5.0 software was used to conduct Meta analysis after methodological evaluation data extraction.Results: Six RCTs were identified,which included 536 patients with ARDS(250cases with glucocorticoid,254 cases without glucocorticoid), 104 cases died in 250 cases with glucocorticoid,and 109 cases died in 254 cases without glucocorticoid.Mortality(OR=0.50,95% CI 0.27~0.95)and hospital stay(WMD=-1.99,95% CI-3.05~-0.93)was statistically reduced in glucocorticoid group.Conclusions: As an adjunctive therapy in severe pneumonia, glucocorticoid reduced mortality and hospital stay. Due to a lack of well designed RCTs, further adequately powered randomized trials, especially in severe population are needed to confirm this potentially beneficial effect.