https://www.cidrap.umn.edu/pneumoni...-risk-pneumonia-death-28-researchers-estimate
Corticosteroids cut risk of pneumonia death by 28%, researchers estimate
Mary Van Beusekom, MS
11 minutes ago.
Pneumonia
University Medical Center Rotterdam researchers in the Netherlands led the analysis of eight trials published before July 1, 2024, that used risk and effect modeling and the intent-to-treat principle to compare adjuvant corticosteroid treatment with a placebo in 3,224 hospitalized CAP patients.
For risk modeling, patients were classified as having severe or less-severe CAP based on the Pneumonia Severity Index (PSI). For effect modeling, the researchers trained a corticosteroid-effect model on six trials, externally validating it with data from two trials received after model preregistration. The model classified patients as either deriving predicted or no predicted benefit from supplemental corticosteroids.
"Despite several randomised controlled trials (RCTs) on the use of adjuvant treatment with corticosteroids in patients with community-acquired pneumonia (CAP), the effect of this intervention on mortality remains controversial," the study authors noted.
Treatment effect depended on C-reactive protein level
A total of 246 patients (7.6%) died within 30 days of diagnosis (6.6% of 1,618 in the corticosteroid group vs 140 [8.7%] of 1,606 in the placebo group; odds ratio [OR], 0.72, or a 28% reduction).
Overall, adjuvant therapy with corticosteroids significantly reduces 30-day mortality in patients hospitalised with CAP.
The corticosteroid-effect model, which selected C-reactive protein (CRP, a marker of inflammation), showed significant heterogeneity of treatment effect (HTE) during external validation in the two most recent trials. In these trials, 154 of 1,355 patients (11.4%) patients died by 30 days (88 of 671 [13.1%] in the placebo group vs 66 of 684 [9.6%] in the corticosteroid group; OR, 0.71).
Among 725 patients predicted to derive no benefit from corticosteroids (CRP, up to 204 milligrams per liter [mg/L]), no significant effect was seen (OR, 0.98), while for the 630 predicted to derive benefit (CRP, more than 204 mg/L), 39 of 301 placebo recipients (13.0%) died, compared with 20 of 329 (6.1%) in the corticosteroid group (OR, 0.43).
No significant HTE was seen between less-severe and severe CAP. Corticosteroids significantly increased the risk of hyperglycemia (44 of 344 [12.8%] in the placebo group vs 84 of 339 [24.8%] corticosteroid recipients; OR, 2.50) and hospital readmission (30 of 814 [3.7%] in the placebo group vs 57 of 819 [7.0%] in the corticosteroid group; OR, 1.95).
"Overall, adjuvant therapy with corticosteroids significantly reduces 30-day mortality in patients hospitalised with CAP," the researchers wrote. "The treatment effect varied significantly among subgroups based on CRP concentrations, with a substantial mortality reduction observed only in patients with high baseline CRP."
Corticosteroids cut risk of pneumonia death by 28%, researchers estimate
Mary Van Beusekom, MS
11 minutes ago.
Pneumonia
The use of corticosteroids in patients hospitalized for community-acquired pneumonia (CAP) lowers the risk of death by 30 days by 28%, concludes a meta-analysis of eight randomized clinical trials published yesterday in The Lancet Respiratory Medicine.University Medical Center Rotterdam researchers in the Netherlands led the analysis of eight trials published before July 1, 2024, that used risk and effect modeling and the intent-to-treat principle to compare adjuvant corticosteroid treatment with a placebo in 3,224 hospitalized CAP patients.
For risk modeling, patients were classified as having severe or less-severe CAP based on the Pneumonia Severity Index (PSI). For effect modeling, the researchers trained a corticosteroid-effect model on six trials, externally validating it with data from two trials received after model preregistration. The model classified patients as either deriving predicted or no predicted benefit from supplemental corticosteroids.
"Despite several randomised controlled trials (RCTs) on the use of adjuvant treatment with corticosteroids in patients with community-acquired pneumonia (CAP), the effect of this intervention on mortality remains controversial," the study authors noted.
Treatment effect depended on C-reactive protein level
A total of 246 patients (7.6%) died within 30 days of diagnosis (6.6% of 1,618 in the corticosteroid group vs 140 [8.7%] of 1,606 in the placebo group; odds ratio [OR], 0.72, or a 28% reduction).
Overall, adjuvant therapy with corticosteroids significantly reduces 30-day mortality in patients hospitalised with CAP.
The corticosteroid-effect model, which selected C-reactive protein (CRP, a marker of inflammation), showed significant heterogeneity of treatment effect (HTE) during external validation in the two most recent trials. In these trials, 154 of 1,355 patients (11.4%) patients died by 30 days (88 of 671 [13.1%] in the placebo group vs 66 of 684 [9.6%] in the corticosteroid group; OR, 0.71).
Among 725 patients predicted to derive no benefit from corticosteroids (CRP, up to 204 milligrams per liter [mg/L]), no significant effect was seen (OR, 0.98), while for the 630 predicted to derive benefit (CRP, more than 204 mg/L), 39 of 301 placebo recipients (13.0%) died, compared with 20 of 329 (6.1%) in the corticosteroid group (OR, 0.43).
No significant HTE was seen between less-severe and severe CAP. Corticosteroids significantly increased the risk of hyperglycemia (44 of 344 [12.8%] in the placebo group vs 84 of 339 [24.8%] corticosteroid recipients; OR, 2.50) and hospital readmission (30 of 814 [3.7%] in the placebo group vs 57 of 819 [7.0%] in the corticosteroid group; OR, 1.95).
"Overall, adjuvant therapy with corticosteroids significantly reduces 30-day mortality in patients hospitalised with CAP," the researchers wrote. "The treatment effect varied significantly among subgroups based on CRP concentrations, with a substantial mortality reduction observed only in patients with high baseline CRP."