Lancet Respir Med

CRP levels guide corticosteroid use in pneumonia

April 8, 2025

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

Results: Overall, 7.6% of patients died within 30 days, with lower mortality in the corticosteroid group (6.6%) compared with the placebo group (8.7%) (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.56–0.94; p=0.017). The corticosteroid-effect model identified significant HTE, showing a substantial mortality reduction in patients with high baseline CRP (>204 mg/L) (OR, 0.43; 95% CI, 0.25-0.76; p interaction=0.026). However, no significant benefit was observed in patients with lower CRP levels. Corticosteroid therapy increased the risk of hyperglycemia (OR, 2.50; 95% CI, 1.63-3.83; p<0.0001) and hospital readmission (OR, 1.95; 95% CI, 1.24-3.07; p=0.0038).

Clinical impact: Corticosteroid therapy can significantly reduce 30-day mortality in hospitalized patients with severe CAP, particularly those with high CRP levels. However, the increased risk of hyperglycemia and hospital readmission should be considered when prescribing corticosteroids. These findings support the targeted use of corticosteroids in specific subgroups of CAP patients to maximize benefits and minimize risks.

Source:

Smit JM, et al. (2025, March). 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/