There were no statistically significant differences in pneumonia recurrence, hospital readmission, ICU admission, or all-cause mortality. Patients treated with prednisone were more likely to experience hyperglycemia that required insulin treatment during admission (19% vs 11%; odds ratio=1.96; 95% CI, 1.31-2.93; P=.001).
WHAT'S NEW: This large, good-quality study reinforces previous evidence
This is the largest good-quality RCT to explore the impact of corticosteroid treatment on less severe CAP. Previous studies suggested that corticosteroids may decrease the duration of illness, but this is the first rigorous study to show a clear decrease in both time to clinical stability and length of hospital stay.
Also, this study used an easy-to-administer dose of oral steroids, instead of the several-day course of IV steroids used in most other studies. The findings from this study were incorporated into a 2015 meta-analysis that confirmed that corticosteroid treatment in patients with less severe CAP results in a shorter length of hospital stay and decreased time to clinical stability.7
CAVEATS: It's unclear whether steroids can benefit nonhospitalized patients
Because this study included hospitalized patients only, it’s not clear whether corticosteroids have a role in outpatient treatment of CAP. Additionally, while this was a large, well performed study, it did not have a sufficient number of patients to examine whether corticosteroids impact mortality among patients with CAP. Finally, the average length of hospital stay reported in this study was approximately 1.5 days longer than the typical length of stay in the United States.2 The average length of stay has varied widely in studies examining corticosteroids in CAP, but good-quality studies have consistently shown a median reduction in length of stay of one day.7
CHALLENGES TO IMPLEMENTATION: Steroids carry a risk of adverse events, including hyperglycemia
Treatment with prednisone increases the risk of corticosteroid-related adverse events, primarily hyperglycemia and the need for insulin. This may not be well received by patients or providers. However, these adverse effects appear to resolve quickly after treatment, and do not impact the overall time to clinical stability.
ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
