Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyApril 2025
Patients admitted to medical floors with community-acquired pneumonia did not benefit from systemic corticosteroids.
A recent large randomised trial and subsequent meta-analysis demonstrated a survival benefit for systemic corticosteroids in managing severe community-acquired pneumonia (CAP; NEJM JW Gen Med Apr 15 2023 and N Engl J Med 2023; 388: 1931-1941), but patients with less severe disease did not benefit (NEJM JW Gen Med Dec 15 2023 and Clin Infect Dis 2023; 77: 1704-1713). In this retrospective cohort study of 11,500 patients with CAP who were admitted to general medicine units in seven Canadian hospitals, researchers compared outcomes for patients who received systemic corticosteroids (about 10% of patients) and those who did not. Patients admitted to intensive care units and those with chronic lung disease or COVID-19 infection were excluded.
In an adjusted analysis, patients who received systemic corticosteroids were significantly more likely to die in the hospital than were patients who did not receive steroids (8.0% vs 6.3%; p=0.03). No differences were noted in intensive care admissions, hospital length of stay or 30-day readmissions.
Comment: This study is described as ‘realworld,’ but the authors acknowledge that selection bias and unmeasured confounding probably drove the slightly higher mortality in the corticosteroid group. They went so far as to state that ‘we do not believe ... glucocorticoids caused harm ...’. In the end, these data will not change my practice of adding steroids for patients who are hospitalised with severe CAP – since this practice is supported by recent guidelines (Crit Care Med 2024; 52: e219e233) – and withholding steroid therapy in patients who have lesssevere CAP.
Daniel D. Dressler, MD, MSc, MHM, FACP, Professor of Medicine, Emory University School of Medicine, Atlanta, USA.
Malecki S, et al. Real-world use of glucocorticoids and clinical outcomes in adults hospitalized with community-acquired pneumonia on medical wards. J Hosp Med 2024; 19: 1001-1009.
This summary is taken from the following Journal Watch titles: General Medicine, Hospital Medicine.