Gu Xue, Yang Penglei, Yu Lina, Yuan Jun, Zhang Ying, Yuan Zhou, Chen Lianxin, Zhang Xiaoli, Chen Qihong
Department of Critical Care Medicine, Jiangdu People'S Hospital Affiliated to Yangzhou University, Yangzhou, 225200, Jiangsu, China.
Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.
Eur J Med Res. 2025 Mar 28;30(1):215. doi: 10.1186/s40001-025-02487-6.
Severe community-acquired pneumonia (sCAP) is associated with higher morbidity and mortality. The use of glucocorticoids to improve the prognosis of severe community-acquired pneumonia remains a topic of controversy.
Following the guidelines given in the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), we conducted a systematic review and meta-analysis to evaluate the effects of glucocorticoids on mortality and duration of mechanical ventilation in patients with sCAP. Randomized controlled studies investigating the use of glucocorticoids in the treatment of sCAP were extracted from PubMed, Embase, Cochrane Library, and Web of Science. Statistical analysis was performed to compare the differences in in-hospital mortality, mechanical ventilation duration, gastrointestinal bleeding, secondary infection, and other outcome measures between the glucocorticoid group and the control group.
A total of 8 studies involving 1769 patients were included in the analysis. The hospital mortality in the glucocorticoid group was significantly lower than that in the control group [8 studies, relative risk (RR) 0.59; 95% CI 0.47-0.76, p < 0.01. I = 25%, low certainty]. The duration of mechanical ventilation in the glucocorticoid group was significantly shorter than that in the control group [Mean Difference (MD) -3.08; 95% CI -4.96 to -1.19, p < 0.01; I = 0%, low certainty]. There was no significant difference in the incidence of gastrointestinal bleeding (RR 0.94; 95% CI 0.55-1.63, p = 0.84, I = 0%, low certainty) or secondary infection (RR 0.85; 95% CI 0.58-1.25, p = 0.85, I = 2%, moderate certainty) between the glucocorticoid group and the control group. In subgroup analysis, mortality was significantly lower in the hydrocortisone group compared to the control group (6.3% vs. 14.6%, RR 0.43; 95% CI 0.29-0.62, p < 0.01, I = 0%, very low certainty). However, there was no significant difference in mortality between the methylprednisolone group and the control group (15.6% vs. 19.9%, RR 0.78; 95% CI 0.57-1.08, p = 0.14, I = 0%, moderate certainty).
Glucocorticoids can reduce mortality in patients with sCAP, and the effect may vary depending on the type and the dose of glucocorticoids used. Additionally, glucocorticoid treatment can lead to a shorter duration of mechanical ventilation, as well as the length of ICU stay, without increasing the risk of gastrointestinal bleeding or secondary infection in patients with sCAP. PROSPERO registration: CRD42023416525.
重症社区获得性肺炎（sCAP）与较高的发病率和死亡率相关。使用糖皮质激素改善重症社区获得性肺炎的预后仍是一个有争议的话题。
按照系统评价和Meta分析的首选报告项目（PRISMA）中给出的指南，我们进行了一项系统评价和Meta分析，以评估糖皮质激素对sCAP患者死亡率和机械通气时间的影响。从PubMed、Embase、Cochrane图书馆和科学网中提取了调查糖皮质激素用于治疗sCAP的随机对照研究。进行统计分析以比较糖皮质激素组和对照组在院内死亡率、机械通气时间、胃肠道出血、继发感染及其他结局指标方面的差异。
共有8项研究涉及1769例患者纳入分析。糖皮质激素组的院内死亡率显著低于对照组[8项研究，相对危险度（RR）0.59；95%可信区间（CI）0.47 - 0.76，p < 0.01。I = 25%，低确定性]。糖皮质激素组的机械通气时间显著短于对照组[平均差（MD）-3.08；95% CI -4.96至-1.19，p < 0.01；I = 0%，低确定性]。糖皮质激素组和对照组在胃肠道出血发生率（RR 0.94；95% CI 0.55 - 1.63，p = 0.84，I = 0%，低确定性）或继发感染发生率（RR 0.85；95% CI 0.58 - 1.25，p = 0.85，I = 2%，中度确定性）方面无显著差异。在亚组分析中，氢化可的松组的死亡率显著低于对照组（6.3%对14.6%，RR 0.43；95% CI 0.29 - 0.62，p < 0.01，I = 0%，极低确定性）。然而甲基泼尼松龙组和对照组在死亡率方面无显著差异（15.6%对19.9%，RR 0.78；95% CI 0.57 - 1.08，p = 0.14，I = 0%，中度确定性）。
糖皮质激素可降低sCAP患者的死亡率，其效果可能因所用糖皮质激素的类型和剂量而异。此外，糖皮质激素治疗可使机械通气时间以及重症监护病房住院时间缩短，且不增加sCAP患者胃肠道出血或继发感染的风险。国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42023416525。
