Similarly, corticosteroids attenuate the action of many cytokines involved in the inflammatory response associated with CAP.
However, the results from previously reported RCTs that evaluated the impact of systemic corticosteroids for CAP had large discrepancies with each other.
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Of 54 articles that met the preliminary criteria, we found 10 eligible RCTs comprising 1780 cases.
Our analyses revealed following pooled values by corticosteroids.
OR for all-cause death: 0.80 (95% confidence interval (95% CI) 0.53–1.21) from all studies; 0.41 (95% CI 0.19–0.90) from severe-case subgroup; 0.21 (95% CI 0.0–0.74) from intensive care unit (ICU) subgroup.
Length of ICU stay: −1.30 days (95% CI (−3.04)−0.44).
Length of ICU stay, length of hospital stay, and length to clinical stability in the form of a hazard ratio (HR) or mean difference were also meta-analyzed.
If both an intention-to-treat analysis and per-protocol-analysis were conducted, we adopted the result from the intention-to-treat analysis.
Previous meta-analyses used different criteria of “severe pneumonia”.
Here, we selected studies that clearly indicated “severe CAP” in the title and/or abstract and studies limited to ICU cases.
Prednisolone (PSL), hydrocortisone (HC), methylprednisolone (m PSL), and dexamethasone (DEX) were administered for four, three, two, and one trial, respectively.