Association between Glucocorticoids and Mortality in Patients with Severe Pneumonia: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials

Objective. To explore the associations between glucocorticoid use and the clinical outcome of patients with severe pneumonia. Methods. Medical databases including PubMed, EMBASE, and ScienceDirect were searched for relevant literature. Two independent researchers extracted the primary endpoint from the included literature. The Cochrane <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>Q</a:mi> </a:math> test and <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:msup> <c:mrow> <c:mi>I</c:mi> </c:mrow> <c:mrow> <c:mn>2</c:mn> </c:mrow> </c:msup> </c:math> statistics were used to evaluate the interstudy heterogeneity. The combined risk estimates were calculated by random effect model, and the source of heterogeneity was evaluated by subgroup analysis. Funnel plot and Egger’s test were used to assess publication bias. <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo><</e:mo> <e:mn>0.05</e:mn> </e:math> denoted statistical significance. Results. A total of 12 literature, including 8171 patients with 1083 deaths, were included in this study for meta-analysis. The use of glucocorticoids significantly increased the mortality ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mtext>RR</g:mtext> <g:mo>=</g:mo> <g:mn>1.44</g:mn> </g:math> , 95% CI: 1.13, 1.84, <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>P</i:mi> <i:mo><</i:mo> <i:mn>0.001</i:mn> </i:math> ), the risk of requiring mechanical ventilation ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mtext>RR</k:mtext> <k:mo>=</k:mo> <k:mn>1.62</k:mn> </k:math> , 95% CI: 1.30, 2.02, <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>P</m:mi> <m:mo><</m:mo> <m:mn>0.001</m:mn> </m:math> ), and the incidence of nosocomial infection ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mtext>RR</o:mtext> <o:mo>=</o:mo> <o:mn>1.36</o:mn> </o:math> , 95% CI: 1.01, 1.82, <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>P</q:mi> <q:mo>=</q:mo> <q:mn>0.04</q:mn> </q:math> ) in patients with severe pneumonia as compared with the control group. In addition, the use of glucocorticoids did not seem to be associated with length of treatment in the intensive care unit ( <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mtext>mean</s:mtext> <s:mtext> </s:mtext> <s:mtext>difference</s:mtext> <s:mo>=</s:mo> <s:mn>1.47</s:mn> </s:math> , 95% CI: -1.04, 3.96, <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mi>P</u:mi> <u:mo>=</u:mo> <u:mn>0.25</u:mn> </u:math> ) and the length of hospital stay ( <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"> <w:mtext>mean</w:mtext> <w:mtext> </w:mtext> <w:mtext>difference</w:mtext> <w:mo>=</w:mo> <w:mn>0.55</w:mn> </w:math> , 95% CI: -3.90, 4.99, <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"> <y:mi>P</y:mi> <y:mo>=</y:mo> <y:mn>0.81</y:mn> </y:math> ). Conclusion. The use of glucocorticoids may increase the mortality, the incidence of hospital-acquired pneumonia, and the need for mechanical ventilation in patients with severe pneumonia.