Ann Intern Med. 2015 Oct 6;163(7):519-28. doi: 10.7326/M15-0715.
Community-acquired pneumonia (CAP) is common and often severe.
To examine the effect of adjunctive corticosteroid therapy on mortality, morbidity, and duration of hospitalization in patients with CAP.
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through 24 May 2015.
Randomized trials of systemic corticosteroids in hospitalized adults with CAP.
Two reviewers independently extracted study data and assessed risk of bias. Quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation system by consensus among the authors.
The median age was typically in the 60s, and approximately 60% of patients were male. Adjunctive corticosteroids were associated with possible reductions in all-cause mortality (12 trials; 1974 patients; risk ratio [RR], 0.67 [95% CI, 0.45 to 1.01]; risk difference [RD], 2.8%; moderate certainty), need for mechanical ventilation (5 trials; 1060 patients; RR, 0.45 [CI, 0.26 to 0.79]; RD, 5.0%; moderate certainty), and the acute respiratory distress syndrome (4 trials; 945 patients; RR, 0.24 [CI, 0.10 to 0.56]; RD, 6.2%; moderate certainty). They also decreased time to clinical stability (5 trials; 1180 patients; mean difference, -1.22 days [CI, -2.08 to -0.35 days]; high certainty) and duration of hospitalization (6 trials; 1499 patients; mean difference, -1.00 day [CI, -1.79 to -0.21 days]; high certainty). Adjunctive corticosteroids increased frequency of hyperglycemia requiring treatment (6 trials; 1534 patients; RR, 1.49 [CI, 1.01 to 2.19]; RD, 3.5%; high certainty) but did not increase frequency of gastrointestinal hemorrhage.
There were few events and trials for many outcomes. Trials often excluded patients at high risk for adverse events.
For hospitalized adults with CAP, systemic corticosteroid therapy may reduce mortality by approximately 3%, need for mechanical ventilation by approximately 5%, and hospital stay by approximately 1 day.
None.
社区获得性肺炎（CAP）很常见，且通常较为严重。
研究辅助皮质类固醇治疗对 CAP 患者死亡率、发病率和住院时间的影响。
通过 2015 年 5 月 24 日的 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库进行检索。
对住院成人 CAP 患者进行全身性皮质类固醇治疗的随机试验。
两名评审员独立提取研究数据并评估偏倚风险。作者之间通过共识使用推荐评估、制定与评估分级系统评估证据质量。
中位年龄通常为 60 多岁，约 60%的患者为男性。辅助皮质类固醇治疗可能降低全因死亡率（12 项试验；1974 例患者；风险比[RR]，0.67 [95%CI，0.45 至 1.01]；风险差[RD]，2.8%；中等确定性）、机械通气需求（5 项试验；1060 例患者；RR，0.45 [CI，0.26 至 0.79]；RD，5.0%；中等确定性）和急性呼吸窘迫综合征（4 项试验；945 例患者；RR，0.24 [CI，0.10 至 0.56]；RD，6.2%；中等确定性）。它们还可缩短临床稳定时间（5 项试验；1180 例患者；平均差，-1.22 天[CI，-2.08 至-0.35 天]；高确定性）和住院时间（6 项试验；1499 例患者；平均差，-1.00 天[CI，-1.79 至-0.21 天]；高确定性）。辅助皮质类固醇治疗可增加需要治疗的高血糖症的发生率（6 项试验；1534 例患者；RR，1.49 [CI，1.01 至 2.19]；RD，3.5%；高确定性），但不会增加胃肠道出血的发生率。
许多结局的事件和试验较少。试验往往排除了发生不良事件风险较高的患者。
对于住院的 CAP 成人患者，全身性皮质类固醇治疗可能使死亡率降低约 3%，机械通气需求降低约 5%，住院时间缩短约 1 天。
无。
