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Published online before print August 9, 2007
Eur Respir J 2007, doi:10.1183/09031936.00027607
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ORIGINAL ARTICLE

Effects of systemic steroids in patients with severe community-acquired pneumonia

C. Garcia-Vidal 1*, E. Calbo 1, V. Pascual 1, C. Ferrer 1, S. Quintana 2, J. Garau 1

1 Services of Internal Medicine
2 Intensive Care, Hospital Mutua de Terrassa, University of Barcelona, Barcelona, Spain

* To whom correspondence should be addressed. E-mail: carolgv75{at}hotmail.com.


  Abstract

The benefit of systemic steroids as adjunctive treatment in patients with severe community-acquired pneumonia remains unclear. The aim of our study was to evaluate the impact of corticosteroid treatment on mortality in patients with severe CAP.

Retrospective observational study of a cohort of patients hospitalized with severe CAP, classes IV and V of the PSI score. Information on epidemiological, clinical, and laboratory data, and 30-day mortality were collected from medical charts.

Of the 308 patients evaluated, 238 patients (77%) were treated with standard antimicrobial therapy and 70 (23%) received both antibiotics and systemic steroids. Clinical characteristics were similar between steroids and non-steroids groups except in the prevalence of male gender and the presence of COPD. Systemic steroids were independently associated with a decreased mortality (OR 0.287 IC 95% 0.113–0.732) while severity of CAP (OR 2.923; IC 95% 1.262–6.770) was the only independent factor associated with increased mortality.

Mortality decreased in our cohort of patients with severe CAP that received simultaneous administration of systemic steroids along with antibiotic treatment.

Severity of disease remains the most important risk factor associated with increased mortality.

Keywords:  Community-acquired pneumonia, immune response, immunomodulation, mortality, systemic steroids




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