• Matthias Briel, Simone M C Spoorenberg, Dominic Snijders, Antoni Torres, Silvia Fernandez-Serrano, G Umberto Meduri, Albert Gabarrús, Claudine A Blum, Marco Confalonieri, Benjamin Kasenda, Siemieniuk Reed A C RAC Department of Clinical Epidemiology & Biostatistics, McMaster University, Ontario, Canada. , Wim Boersma, Bos Willem Jan W WJW Department of Internal Medicine, St. Antonius Hospital, Nieuwegein., Mirjam Christ-Crain, Ovidius Study Group, Capisce Study Group, and STEP Study Group.
• Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland.
• Clin. Infect. Dis. 2018 Jan 18; 66 (3): 346-354.

BackgroundOur aim was to evaluate the benefits and harms of adjunctive corticosteroids in adults hospitalized with community-acquired pneumonia (CAP) using individual patient data from randomized, placebo-controlled trials and to explore subgroup differences.MethodsWe systematically searched Medline, Embase, Cochrane Central, and trial registers (all through July 2017). Data from 1506 individual patients in 6 trials were analyzed using uniform outcome definitions. We investigated prespecified effect modifiers using multivariable hierarchical regression, adjusting for pneumonia severity, age, and clustering effects.ResultsWithin 30 days of randomization, 37 of 748 patients (5.0%) assigned to corticosteroids and 45 of 758 patients (5.9%) assigned to placebo died (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], .46 to 1.21; P = .24). Time to clinical stability and length of hospital stay were reduced by approximately 1 day with corticosteroids (-1.03 days; 95% CI, -1.62 to -.43; P = .001 and -1.15 days; 95% CI, -1.75 to -.55; P < .001, respectively). More patients with corticosteroids had hyperglycemia (160 [22.1%] vs 88 [12.0%]; aOR, 2.15; 95% CI, 1.60 to 2.90; P < .001) and CAP-related rehospitalization (33 [5.0%] vs 18 [2.7%]; aOR, 1.85; 95% CI, 1.03 to 3.32; P = .04). We did not find significant effect modification by CAP severity or degree of inflammation.ConclusionsAdjunct corticosteroids for patients hospitalized with CAP reduce time to clinical stability and length of hospital stay by approximately 1 day without a significant effect on overall mortality but with an increased risk for CAP-related rehospitalization and hyperglycemia.© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

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