{"id":24413,"date":"2023-08-22T04:00:00","date_gmt":"2023-08-21T20:00:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24413"},"modified":"2023-08-22T05:48:09","modified_gmt":"2023-08-21T21:48:09","slug":"chest%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e7%9a%ae%e8%b4%a8%e6%bf%80%e7%b4%a0%e5%af%b9%e7%a4%be%e5%8c%ba%e8%8e%b7%e5%be%97%e6%80%a7%e8%82%ba%e7%82%8e%e7%97%85%e6%ad%bb%e7%8e%87%e5%92%8c","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24413","title":{"rendered":"[Chest\u53d1\u8868\u8bba\u6587]\uff1a\u76ae\u8d28\u6fc0\u7d20\u5bf9\u793e\u533a\u83b7\u5f97\u6027\u80ba\u708e\u75c5\u6b7b\u7387\u548c\u4e34\u5e8a\u6cbb\u6108\u7387\u7684\u5f71\u54cd"},"content":{"rendered":"\n

CHEST INFECTIONS: ORIGINAL RESEARCH|\u00a0VOLUME 163, ISSUE 3<\/a>,\u00a0P484-497,\u00a0MARCH 2023Download Full Issue<\/p>\n\n\n\n

Effect of Corticosteroids on Mortality and Clinical Cure in Community-Acquired Pneumonia: A Systematic Review, Meta-analysis, and Meta-regression of Randomized Control Trials<\/h1>\n\n\n\n

Naveed Saleem, Adarsh Kulkarni, Timothy Arthur Chandos Snow, et al<\/h3>\n\n\n\n

<\/a>Chest 2023; 163: 484-497 Published:September 07, 2022<\/h3>\n\n\n\n

DOI:https:\/\/doi.org\/10.1016\/j.chest.2022.08.2229<\/a><\/h3>\n\n\n\n

Background<\/h3>\n\n\n\n

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality. Corticosteroids may be a beneficial adjunct in the treatment of bacterial pneumonia.<\/p>\n\n\n\n

Research Question<\/h3>\n\n\n\n

Is there any benefit of corticosteroid therapy in the management of bacterial CAP among patients requiring hospitalization?<\/p>\n\n\n\n

Study Design and Methods<\/h3>\n\n\n\n

PubMed, Cochrane Library, and Embase were searched to identify randomized controlled trials assessing the use of systemic corticosteroids compared with standard care in the management of CAP. A systematic review, meta-analysis, and Trial Sequential Analysis (TSA) were performed. The primary outcome was all-cause mortality. Secondary outcomes included ICU admission, mechanical ventilation, treatment failure, readmission, and adverse events. Data are presented as risk ratio (RR) with 95% CI, P<\/em> value, heterogeneity (I<\/em>2<\/sup>), and TSA-adjusted CIs.<\/p>\n\n\n\n

Results<\/h3>\n\n\n\n

Sixteen trials met the eligibility criteria. All-cause mortality (16 studies [3,842 patients]; RR, 0.85 [95%\u00a0CI, 0.67-1.07];\u00a0P<\/em>\u00a0= .17;\u00a0I<\/em>2<\/sup>\u00a0= 14%; TSA-adjusted CI, 0.61-1.09), ICU admission (six studies [2,619 patients]; RR, 0.66 [95%\u00a0CI, 0.45-0.97];\u00a0P<\/em>\u00a0= .04;\u00a0I<\/em>2<\/sup>\u00a0= 0%; TSA-adjusted CI, 0.37-1.12), treatment failure (six studies [2,093 patients]; RR, 0.78 [95%\u00a0CI, 0.37-1.67];\u00a0P<\/em>\u00a0= .52;\u00a0I<\/em>2<\/sup>\u00a0= 68%; TSA-adjusted CI, 0.02-25.5), and the incidence of adverse events (six studies [2,487 patients]; RR, 1.10 [95%\u00a0CI, 0.97-1.25];\u00a0P<\/em>\u00a0= .14;\u00a0I<\/em>2<\/sup>\u00a0= 53%; TSA-adjusted CI, 0.82-2.41) were similar between patients receiving corticosteroids and patients assigned to the control group. The need for mechanical ventilation (eight studies [1,457 patients]; RR, 0.51 [95%\u00a0CI, 0.33-0.77];\u00a0P<\/em>\u00a0= .001;\u00a0I<\/em>2<\/sup>\u00a0= 0%; TSA-adjusted CI, 0.20-0.85) was lower among patients receiving corticosteroids compared with those receiving standard care. However, corticosteroid use may be associated with higher rates of hospital readmission (five studies [2,853 patients]; RR, 1.20 [95%\u00a0CI, 1.05-1.38];\u00a0P<\/em>\u00a0= .008;\u00a0I<\/em>2<\/sup>\u00a0= 0%; TSA-adjusted CI, 0.89-1.98).<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Interpretation<\/h3>\n\n\n\n

Corticosteroid therapy is associated with a lower incidence of progression to requiring mechanical ventilation among patients hospitalized with CAP. No association was found between corticosteroid therapy and mortality, treatment failure, or adverse events.<\/p>\n\n\n\n

Trial Registry<\/h3>\n\n\n\n

PROSPERO; No.: CRD42021279359; URL: https:\/\/www.crd.york.ac.uk\/prospero\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

CHEST INFECTIONS: ORIGINAL RESEARCH|\u00a0VOLUME 163, ISSUE […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24413"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24413"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24413\/revisions"}],"predecessor-version":[{"id":24414,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24413\/revisions\/24414"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24413"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24413"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24413"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}