Corticosteroids lower mortality and mechanical ventilation needs in ICU community-acquired pneumonia patients.

This meta-analysis sought to examine the use of Corticosteroids (a class of steroid hormones) in community-acquired pneumonia (CAP) patients, specifically comparing outcomes between those admitted to the intensive care unit (ICU) and those treated in a non-ICU setting.

PubMed, Cochrane, and SCOPUS were systematically explored from their inception until May 2023 for randomized controlled trials (RCTs). Mortality, the requirement for mechanical ventilation, the necessity for ICU admission, and treatment failure were all part of the primary outcomes. The need for hospital readmission, duration of hospitalization, length of ICU stay, occurrences of gastrointestinal (GI) bleeding, secondary infections, and hyperglycemic events were the secondary outcomes. The random-effects model was used to evaluate the findings, considering a p-value < 0.05 as statistically significant.

Eighteen RCTs with 4472 CAP patients were considered. The use of Corticosteroids significantly reduced mortality rates (RR: 0.66; 95% CI: 0.54, 0.81; P < 0.0001) and the need for mechanical ventilation (RR: 0.57; 95% CI: 0.44, 0.73; P < 0.00001).

Additionally, corticosteroid therapy was linked with a substantial decrease in both ICU (MD: -1.67; 95% CI: -2.97, -0.37; P = 0.01) and hospital stays (MD: -1.94; 95% CI: -2.89, -0.98; P = 0.0001). However, it also led to an increased incidence of hyperglycemic events and hospital readmissions.

Corticosteroids contribute to better outcomes among CAP patients by lowering mortality rates and decreasing the requirement for mechanical ventilation. Additional large-scale RCTs with specific stratifications are suggested.