Lancet Respir Med

Corticosteroids reduce mortality in severe community-acquired pneumonia

February 25, 2025

Study details: This individual patient data meta-analysis included eight randomized trials with 3,224 patients hospitalized with community-acquired pneumonia (CAP). The primary endpoint was 30-day all-cause mortality. Patients were classified by pneumonia severity index (PSI) and C-reactive protein (CRP) levels to assess heterogeneity of treatment effect (HTE) of adjuvant corticosteroid therapy.

Results: Overall, corticosteroid therapy significantly reduced 30-day mortality (odds ratio [OR], 0.72, 95% confidence interval [CI], 0.56–0.94, p = 0.017). The corticosteroid-effect model identified significant HTE based on CRP levels. Patients with CRP >204 mg/L showed a substantial mortality reduction (odds ratio [OR], 0.43, 95% CI, 0.25–0.76, p interaction = 0.026), while no significant effect was observed in patients with CRP ≤204 mg/L (OR, 0.98, 95% CI, 0.63–1.50).

Clinical impact: The findings highlight the importance of CRP levels in predicting the benefit of adjuvant corticosteroid therapy in CAP. Clinicians should consider CRP concentrations when deciding on corticosteroid use, in order to target patients most likely to benefit.

Source:

Smit JM, et al. (2025, January 29). Lancet Respir Med. Predicting benefit from adjuvant therapy with corticosteroids in community-acquired pneumonia: a data-driven analysis of randomised trials. https://pubmed.ncbi.nlm.nih.gov/39892408/