Medical Research: What is the background for this study? What are the main findings?
Dr. Siemieniuk: Local and cytokine-mediated systematic inflammatory responses help clear bacterial pathogens in community-acquired pneumonia (CAP), but often they can also cause harm. Pneumonia is the most common cause of the acute respiratory distress syndrome (ARDS), an often fatal inflammatory complication. Two randomized trials were published earlier this year, each of which suggested the possibility of benefit from adjunctive corticosteroid therapy. We decided to perform a systematic review and meta-analysis, taking all available data into consideration.
Corticosteroids may be effective for reducing the incidence of ARDS by 6%, the need for mechanical ventilation by 5%, and mortality by 3% (all moderate confidence). They also reduce time to clinical stability and time to discharge by approximately 1 day (high confidence).
For an interactive summary of findings table that shows the study’s findings, please see: http://isof2.epistemonikos.org/#/finding/550bc6acf30d0c43083e63a0.
Medical Research: What should clinicians and patients take away from your report?
Dr. Siemieniuk: Corticosteroids might improve outcomes for patients hospitalized with community-acquired pneumonia. The argument for using corticosteroids in pneumonia is strongest among those with severe pneumonia. Our recommendations can be found at: http://www.magicapp.org/app#/guideline/516.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Siemieniuk: Future randomized trials would increase the certainty in evidence for corticosteroids in community-acquired pneumonia. In the mean time, it is worth weighing the risks and benefits for the any patient hospitalized withcommunity-acquired pneumonia.
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. [Epub ahead of print 11 August 2015] doi:10.7326/M15-0715
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