Effect of corticosteroids on the clinical course of community-acquired pneumonia: a randomized controlled trial

Silvia Fernández-Serrano, Jordi Dorca, Carolina Garcia-Vidal, Núria Fernández-Sabé, Jordi Carratalà, Ana Fernández-Agüera, Mercè Corominas, Susana Padrones, Francesc Gudiol, Frederic Manresa, Silvia Fernández-Serrano, Jordi Dorca, Carolina Garcia-Vidal, Núria Fernández-Sabé, Jordi Carratalà, Ana Fernández-Agüera, Mercè Corominas, Susana Padrones, Francesc Gudiol, Frederic Manresa

Abstract

Introduction: The benefit of corticosteroids as adjunctive treatment in patients with severe community-acquired pneumonia (CAP) requiring hospital admission remains unclear. This study aimed to evaluate the impact of corticosteroid treatment on outcomes in patients with CAP.

Methods: This was a prospective, double-blind and randomized study. All patients received treatment with ceftriaxone plus levofloxacin and methyl-prednisolone (MPDN) administered randomly and blindly as an initial bolus, followed by a tapering regimen, or placebo.

Results: Of the 56 patients included in the study, 28 (50%) were treated with concomitant corticosteroids. Patients included in the MPDN group show a more favourable evolution of the pO2/FiO2 ratio and faster decrease of fever, as well as greater radiological improvement at seven days. The time to resolution of morbidity was also significantly shorter in this group. Six patients met the criteria for mechanical ventilation (MV): five in the placebo group (22.7%) and one in the MPDN group (4.3%). The duration of MV was 13 days (interquartile range 7 to 26 days) for the placebo group and three days for the only case in the MPDN group. The differences did not reach statistical significance. Interleukin (IL)-6 and C-reactive protein (CRP) showed a significantly quicker decrease after 24 h of treatment among patients treated with MPDN. No differences in mortality were found among groups.

Conclusions: MPDN treatment, in combination with antibiotics, improves respiratory failure and accelerates the timing of clinical resolution of severe CAP needing hospital admission.

Trial registration: International Standard Randomized Controlled Trials Register, ISRCTN22426306.

Figures

Figure 1
Figure 1
Selection of patients for the study.
Figure 2
Figure 2
Comparative evolution of paO2/FIO2 ratio over the days of treatment and between the two study groups. Mean values with 96% Confidence Intervals. Open circles: Placebo. Closed circles: methyl-prednisolone (MPDN). Line: Clamp Spline Interpolation. (P = 0.001 Kruskal-Wallis one-way non-parametric test).
Figure 3
Figure 3
Comparative evolution of C-reactive protein ratio over the days of treatment and between the two study groups. The CPR ratio was calculated by dividing every day value by the CPR value at Day 0. Mean values with 96% confidence Intervals. Open circles: Placebo. Closed Circles: methyl-prednisolone (MPDN). Line: Clamp Spline Interpolation. (P = 0.05 Kruskal-Wallis one-way non-parametric test).

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