Efficacy of glucocorticoids versus placebo on mortality in patients with community-acquired pneumonia: systematic review

Paul E. Hernández-Montes, Department of General Medicine, Hospital General Dr. Aquiles Calles Ramírez, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Tepic, Nayarit, Mexico
Lenyn D. Montes-Sevilla, Departament of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Secretaría de Salud, Mexico City, Mexico

The use of glucocorticoids (GCS) in acute respiratory distress syndrome is well documented; however, their use in community-acquired pneumonia (CAP) is controversial, and their impact on mortality is not well defined. The objective is evaluating the efficacy of GCS use compared to placebo in patients with CAP through a systematic review. A systematic review of the literature was conducted in databases such as PubMed, Scopus, and Web of Science for randomized clinical trials published between 2019 and 2024. Articles were classified according to the level of evidence by the Oxford Center for Evidence-Based Medicine. In the results, seven original articles were included, all of which were randomized clinical trials. The studies included a total of 2847 participants, evaluating outcomes such as mortality, days of mechanical ventilation use, length of hospital stay, need for vasopressor use, development of shock, and ARDS. The use of hydrocortisone showed a significant benefit in reducing mortality at 28 days and the need for mechanical ventilation and vasopressors. In contrast, the use of dexamethasone and methylprednisolone did not show significant differences compared to placebo.

Keywords: Corticosteroids. Pneumonia. Mortality. Placebo. Systematic review.