Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis.
<h4>Background</h4>Community-acquired pneumonia (CAP) induces lung and systemic inflammation, leading to high morbidity and mortality. We systematically reviewed the risks and benefits of adjunctive corticotherapy in the management of patients with CAP.<h4>Methods</h4>We syst...
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| Format: | Article |
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Public Library of Science (PLoS)
2015-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0144032 |
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| author | Christophe Marti Olivier Grosgurin Stephan Harbarth Christophe Combescure Mohamed Abbas Olivier Rutschmann Arnaud Perrier Nicolas Garin |
| author_facet | Christophe Marti Olivier Grosgurin Stephan Harbarth Christophe Combescure Mohamed Abbas Olivier Rutschmann Arnaud Perrier Nicolas Garin |
| author_sort | Christophe Marti |
| collection | DOAJ |
| description | <h4>Background</h4>Community-acquired pneumonia (CAP) induces lung and systemic inflammation, leading to high morbidity and mortality. We systematically reviewed the risks and benefits of adjunctive corticotherapy in the management of patients with CAP.<h4>Methods</h4>We systematically searched Pubmed, Embase and the Cochrane Library for randomized controlled trials comparing adjunctive corticotherapy and antimicrobial therapy with antimicrobial therapy alone in patients with CAP. The primary outcome was 30-day mortality. Secondary outcomes were length of hospital stay, time to clinical stability and severe complications.<h4>Results</h4>14 trials (2077 patients) were included. The reported 30-day mortality was 7.9% (80/1018) among patients treated with adjunctive corticotherapy versus 8.3% (85/1028) among patients treated with antimicrobial therapy alone (RR 0.84; 95%CI 0.55 to1.29). Adjunctive corticotherapy was associated with a reduction of severe complications (RR 0.36; 95%CI 0.23 to 0.56), a shorter length of stay (9.0 days; 95%CI 7.6 to 10.7 vs 10.6 days; 95%CI 7.4 to 15.3) and a shorter time to clinical stability (3.3 days; 95% CI 2.8 to 4.1 vs 4.3 days; 95%CI 3.6 to 5.1). The risk of hyperglycemia was higher among patients treated with adjunctive corticotherapy (RR 1.59; 95%CI 1.06 to 2.38), whereas the risk of gastro-intestinal bleeding was similar (RR 0.83; 95%CI 0.35 to 1.93). In the subgroup analysis based on CAP severity, a survival benefit was found among patients with severe CAP (RR 0.47; 95%CI 0.23 to 0.96).<h4>Conclusion</h4>Adjunctive corticotherapy is associated with a reduction of length of stay, time to clinical stability, and severe complications among patients with CAP, but the effect on mortality remains uncertain. |
| format | Article |
| id | doaj-art-c1c77995eb954537be3e2162a9eb470e |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-c1c77995eb954537be3e2162a9eb470e2025-08-20T03:17:54ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-011012e014403210.1371/journal.pone.0144032Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis.Christophe MartiOlivier GrosgurinStephan HarbarthChristophe CombescureMohamed AbbasOlivier RutschmannArnaud PerrierNicolas Garin<h4>Background</h4>Community-acquired pneumonia (CAP) induces lung and systemic inflammation, leading to high morbidity and mortality. We systematically reviewed the risks and benefits of adjunctive corticotherapy in the management of patients with CAP.<h4>Methods</h4>We systematically searched Pubmed, Embase and the Cochrane Library for randomized controlled trials comparing adjunctive corticotherapy and antimicrobial therapy with antimicrobial therapy alone in patients with CAP. The primary outcome was 30-day mortality. Secondary outcomes were length of hospital stay, time to clinical stability and severe complications.<h4>Results</h4>14 trials (2077 patients) were included. The reported 30-day mortality was 7.9% (80/1018) among patients treated with adjunctive corticotherapy versus 8.3% (85/1028) among patients treated with antimicrobial therapy alone (RR 0.84; 95%CI 0.55 to1.29). Adjunctive corticotherapy was associated with a reduction of severe complications (RR 0.36; 95%CI 0.23 to 0.56), a shorter length of stay (9.0 days; 95%CI 7.6 to 10.7 vs 10.6 days; 95%CI 7.4 to 15.3) and a shorter time to clinical stability (3.3 days; 95% CI 2.8 to 4.1 vs 4.3 days; 95%CI 3.6 to 5.1). The risk of hyperglycemia was higher among patients treated with adjunctive corticotherapy (RR 1.59; 95%CI 1.06 to 2.38), whereas the risk of gastro-intestinal bleeding was similar (RR 0.83; 95%CI 0.35 to 1.93). In the subgroup analysis based on CAP severity, a survival benefit was found among patients with severe CAP (RR 0.47; 95%CI 0.23 to 0.96).<h4>Conclusion</h4>Adjunctive corticotherapy is associated with a reduction of length of stay, time to clinical stability, and severe complications among patients with CAP, but the effect on mortality remains uncertain.https://doi.org/10.1371/journal.pone.0144032 |
| spellingShingle | Christophe Marti Olivier Grosgurin Stephan Harbarth Christophe Combescure Mohamed Abbas Olivier Rutschmann Arnaud Perrier Nicolas Garin Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis. PLoS ONE |
| title | Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis. |
| title_full | Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis. |
| title_fullStr | Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis. |
| title_full_unstemmed | Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis. |
| title_short | Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis. |
| title_sort | adjunctive corticotherapy for community acquired pneumonia a systematic review and meta analysis |
| url | https://doi.org/10.1371/journal.pone.0144032 |
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