Zhu Liangdong, Zeng Jia, Li Hui, Li Keyu, Chen Xia
The First Hospital of Changsha, Changsha, China.
National Respiratory Center of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
BMC Pulm Med. 2025 Apr 30;25(1):210. doi: 10.1186/s12890-025-03679-w.
Severe community-acquired pneumonia (CAP) is a potentially fatal pulmonary disease. Although studies have investigated the efficacy and safety of corticosteroids for severe CAP, the results remain inconsistent. Moreover, there is a lack of sufficient evidence to rank the effects of different types of corticosteroids. The aim of this study is to elucidate the effects of different corticosteroids in patients with severe CAP.
We searched PubMed, Embase, Cochrane Library, and Web of Science comprehensively, encompassing all publications with a search deadline of March 31, 2024. Only randomized controlled trials (RCTs) involving the treatment of severe CAP with corticosteroids were included. The primary efficacy outcome was all-cause mortality, secondary efficacy outcome was mechanical ventilation (MV), and safety outcome was the incidence of serious adverse events (SAEs).
A total of 11 studies, involving 2042 participants, compared four corticosteroids (hydrocortisone, dexamethasone, prednisolone, methylprednisolone). The included trials were all corticosteroid versus placebo comparisons, resulting in a star-shaped network. Among the four corticosteroids, only hydrocortisone was significantly more effective at reducing mortality than placebo (RR, 0.35; 95% CrI, 0.14-0.64). Additionally, hydrocortisone reduced the need for MV (RR, 0.73; 95% CrI, 0.51-0.93). Furthermore, subgroup analysis indicated that low-to-moderate doses, short-course corticosteroids are associated with a reduction in both mortality and the need for MV.
In the evaluated corticosteroid regimen, hydrocortisone might be an effective measure to reduce all-cause mortality in patients with severe CAP.
The present study is a meta-analysis and literature review, therefore clinical trial number is not applicable.
重症社区获得性肺炎（CAP）是一种潜在致命的肺部疾病。尽管已有研究调查了皮质类固醇治疗重症CAP的疗效和安全性，但其结果仍不一致。此外，缺乏足够证据对不同类型皮质类固醇的效果进行排序。本研究旨在阐明不同皮质类固醇对重症CAP患者的影响。
我们全面检索了PubMed、Embase、Cochrane图书馆和Web of Science，纳入检索截止日期为2024年3月31日的所有出版物。仅纳入涉及用皮质类固醇治疗重症CAP的随机对照试验（RCT）。主要疗效结局为全因死亡率，次要疗效结局为机械通气（MV），安全性结局为严重不良事件（SAE）的发生率。
共有11项研究，涉及2042名参与者，比较了四种皮质类固醇（氢化可的松、地塞米松、泼尼松龙、甲泼尼龙）。纳入的试验均为皮质类固醇与安慰剂的比较，形成了一个星形网络。在这四种皮质类固醇中，只有氢化可的松在降低死亡率方面比安慰剂显著更有效（RR，0.35；95% CrI，0.14 - 0.64）。此外，氢化可的松减少了MV的需求（RR，0.73；95% CrI，0.51 - 0.93）。此外，亚组分析表明，低至中等剂量、短疗程的皮质类固醇与死亡率降低和MV需求减少均相关。
在所评估的皮质类固醇治疗方案中，氢化可的松可能是降低重症CAP患者全因死亡率的有效措施。
本研究为荟萃分析和文献综述，因此不适用临床试验编号。
