Systemic corticosteroids for community-acquired pneumonia: Reasons for use and lack of benefit on outcome
Article first published online: 25 JAN 2013
© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology
Volume 18, Issue 2, pages 263–271, February 2013
How to Cite
POLVERINO, E., CILLÓNIZ, C., DAMBRAVA, P., GABARRÚS, A., FERRER, M., AGUSTÍ, C., PRINA, E., MONTULL, B., MENENDEZ, R., NIEDERMAN, M. S. and TORRES, A. (2013), Systemic corticosteroids for community-acquired pneumonia: Reasons for use and lack of benefit on outcome. Respirology, 18: 263–271. doi: 10.1111/resp.12013
- Issue published online: 25 JAN 2013
- Article first published online: 25 JAN 2013
- Accepted manuscript online: 7 NOV 2012 06:16AM EST
- Manuscript Accepted: 25 AUG 2012
- Manuscript Revised: 9 AUG 2012
- Manuscript Received: 29 MAY 2012
- adjunctive therapy;
- clinical stability;
- community-acquired pneumonia;
- systemic corticosteroid
Background and objective
Although the benefits of systemic corticosteroids in community-acquired pneumonia (CAP) are not clear, their use is frequent in clinical practice. We described the frequency of this practice, patients' characteristics and its clinical impact.
We investigated all adult CAP patients visited between June 1997 and January 2008 (n = 3257).
Two hundred and sixty patients received systemic corticosteroids (8%) with a mean daily dose of 45 (33) mg (median, 36 mg/day). Patients receiving corticosteroids were older (74 (13) vs 65 (19) years), had more comorbidities (respiratory, 59% vs 38%, cardiac, 29% vs 16%, etc.), higher Pneumonia Severity Index (Fine IV–V, 76% vs 50%) and had received inhaled corticosteroids (36% vs 15%) and previous antibiotics (31% vs 23%) more frequently (P < 0.01, each). Significant predictors of corticosteroid administration were: chronic obstructive pulmonary disease (odds ratio (OR), 1.91), fever (OR, 0.59), expectoration (OR, 1.59), creatinine (+1 mg/dL, OR, 0.92), SaO2 ≥ 92% (OR, 0.46), C-reactive protein (+5 mg/dL; OR, 0.92) and cardiac failure (OR, 1.76). Mortality (6% vs 7%; P = 0.43) and time to clinical stability (4 (3–6) vs 5 (3–7) days; P = 0.11) did not differ between the two groups, while length of hospital stay was longer for the steroid group (9 (6–14) vs 6 (3–9) days; P < 0.01).
The main reasons for administering systemic steroids were the presence of chronic respiratory comorbidity or severe clinical presentation, but therapy did not influence mortality or clinical stability; by contrast, steroid administration was associated with prolonged length of stay. Nevertheless the steroid group did not show an increased mortality as it was expected according to the initial Pneumonia Severity Index score. Influence of steroids on outcomes of CAP need to be further investigated through randomized clinical trial.