Severe CAP – Consider Steroids

Steroids for Hospitalized Patients with Community Acquired Pneumonia

By Zach Adams, OSU EM Resident // Edited by Michael Barrie, OSU EM Assistant Professor

Do steroids help improve mortality in Pneumonia? An article in the Annals of Internal Medicine attempted to set the record straight in the meta-analysis Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis

What did they find?

Reduction in all-cause mortality (RR 0.67, CI 0.45-1.01)
Reduction in need for mechanical ventilation (RR 0.45, CI 0.26-0.79)
Reduction in ARDS (RR 0.24, CI 0.10-0.56)
Decreased time to clinical stability (mean difference 1.22 days, CI -2.08 to -0.35 days)
Decreased duration of hospitalization (-1.00 days, CI -1.79 to -0.21 days)

The side effects:

Increased frequency of hyperglycemia requiring treatment, which would be expected

No increased frequency of GI hemorrhage.

The conclusions:

  • 5% reduction in the need for mechanical ventilation and ARDS (NNT 20)
  • Reduction in time to clinical stability by 1 day
  • Reduced hospital length of stay by 1 day
  • Some mortality benefit, especially in sicker patients

Finally:

“Decision makers should seriously consider the use of corticosteroids in patients hospitalized with CAP, particularly in those who are more severely affected.”

Of note, these were community acquired pneumonia cases that were hospitalized, and there was no mention for those who might be managed on an outpatient basis.

Practice changer? Maybe giving steroids upfront in the ED with our antibiotics for patients we admit might set them up, especially for the boarders who may be with us for a while.

 

Reference:

  1. Siemieniuk RA, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M, et al. Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163:519-528. doi:10.7326/M15-0715
Advertisements