• Reed A C Siemieniuk, Maureen O Meade, Pablo Alonso-Coello, Matthias Briel, Nathan Evaniew, Manya Prasad, Paul E Alexander, Yutong Fei, Per O Vandvik, Mark Loeb, and Gordon H Guyatt.
• Ann. Intern. Med. 2015 Oct 6; 163 (7): 519-28.

BackgroundCommunity-acquired pneumonia (CAP) is common and often severe.PurposeTo examine the effect of adjunctive corticosteroid therapy on mortality, morbidity, and duration of hospitalization in patients with CAP.Data SourcesMEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through 24 May 2015.Study SelectionRandomized trials of systemic corticosteroids in hospitalized adults with CAP.Data ExtractionTwo reviewers independently extracted study data and assessed risk of bias. Quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation system by consensus among the authors.Data SynthesisThe median age was typically in the 60s, and approximately 60% of patients were male. Adjunctive corticosteroids were associated with possible reductions in all-cause mortality (12 trials; 1974 patients; risk ratio [RR], 0.67 [95% CI, 0.45 to 1.01]; risk difference [RD], 2.8%; moderate certainty), need for mechanical ventilation (5 trials; 1060 patients; RR, 0.45 [CI, 0.26 to 0.79]; RD, 5.0%; moderate certainty), and the acute respiratory distress syndrome (4 trials; 945 patients; RR, 0.24 [CI, 0.10 to 0.56]; RD, 6.2%; moderate certainty). They also decreased time to clinical stability (5 trials; 1180 patients; mean difference, -1.22 days [CI, -2.08 to -0.35 days]; high certainty) and duration of hospitalization (6 trials; 1499 patients; mean difference, -1.00 day [CI, -1.79 to -0.21 days]; high certainty). Adjunctive corticosteroids increased frequency of hyperglycemia requiring treatment (6 trials; 1534 patients; RR, 1.49 [CI, 1.01 to 2.19]; RD, 3.5%; high certainty) but did not increase frequency of gastrointestinal hemorrhage.LimitationsThere were few events and trials for many outcomes. Trials often excluded patients at high risk for adverse events.ConclusionFor hospitalized adults with CAP, systemic corticosteroid therapy may reduce mortality by approximately 3%, need for mechanical ventilation by approximately 5%, and hospital stay by approximately 1 day.Primary Funding SourceNone.

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