Corticosteroid therapy for pneumonia

Zumla, Alimuddin, Bates, Matthew and Maeurer, Markus (2015) Corticosteroid therapy for pneumonia. Lancet, 386 (9997). p. 955. ISSN 0140-6736

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In a randomised controlled trial (RCT), treatment with oral prednisone for 7 days shortened time to clinical stability, as defined by stabilisation of vital signs and symptoms, and hastened hospital discharge in patients with community-acquired pneumonia (CAP).1
Claudine Blum and colleagues1 suggest that treatment with glucocorticoids would enhance recovery from CAP, reduce hospital costs, and could decrease morbidity and mortality. In a cohort study of patients with CAP,2 earlier time to clinical stability was associated with shorter hospital stay and lower in-hospital mortality, but not with 30-day all-cause and disease-specific mortality, and readmission rates. In four of five RCTs,3 glucocorticoid therapy reduced duration of mechanical ventilation for patients with acute respiratory distress syndrome (ARDS), whereas only one small trial showed the survival benefit of glucocorticoid.3 A meta-analysis4 of eight RCTs did not show any benefit of glucocorticoid treatment in patients with ARDS in terms of intensive care unit mortality or 60-day mortality, and in a subgroup analysis, glucocorticoid significantly increased mortality in those with influenza-related ARDS.4 The effect of glucocorticoid might not be sustainable in the late course of CAP, and could even be harmful in patients with severe CAP or ARDS.

Time to clinical stability might not be an adequate way to predict the outcome of patients with CAP who are receiving glucocorticoids. Glucocorticoids might suppress the febrile response, increase systemic vascular resistance and mean arterial pressure, and reduce heart rate during severe infections,5 which might lead to a situation in which a patient is haemodynamically stable, but the infection and inflammation are still advancing.

Keywords:Corticosteroid, Pneumonia
Subjects:A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Science > School of Life Sciences
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ID Code:28362
Deposited On:02 Oct 2017 14:46

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