背景:重症社区获得性肺炎(sCAP)的特点是症状严重,预后不良,特别是近年来新型冠状病毒对全球的影响。糖皮质激素在sCAP中的使用是目前争论的主题。评价糖皮质激素的临床疗效和安全性,为临床合理使用糖皮质激素提供指导。我们进行了这项研究。
方法:我们搜索了PubMed,WebofScience,和中国国家知识基础设施使用以下搜索词:“肺炎”,\"肺炎\",“肺部炎症”,“肺部炎症”,“肺部炎症”,和“肺部炎症”。主要结果包括死亡率和住院时间。次要结果包括机械通气的持续时间,血管活性药物使用的持续时间,消化道出血,和多种感染。Cochrane协作用于评估纳入研究的偏倚风险。Stata/MP14用于荟萃分析。
结果:这些研究包含了1252名接受糖皮质激素的患者和1280名没有接受糖皮质激素的患者的信息。Meta分析显示,在死亡率方面没有差异[风险比(RR)=0.93,95%置信区间(CI):0.81-1.07,P>.05],消化道出血(RR=1.38,95%CI:0.83-2.30,P<.05),激素组和非激素组之间的多重感染(RR=1.17,95%CI:0.90-1.53,P>.05)和住院时间(平均差异[MD]=-0.87,95%CI:-2.35-0.61,P>.05).然而,机械通气的持续时间(MD=-1.54;95%CI,-1.89至-1.12,P<.05)和使用血管活性药物的持续时间(MD=-14.09,95%CI:-15.72至-12.46,P<.05)存在显着差异。
结论:糖皮质激素减少了sCAP患者的机械通气持续时间和血管活性药物的使用时间,而不增加包括高血糖和多重感染在内的不良事件的风险。然而,糖皮质激素与非糖皮质激素组sCAP患者的死亡率和住院时间无显著差异.糖皮质激素可推荐用于合并呼吸衰竭或血流动力学不稳定的sCAP患者。
BACKGROUND: Severe community-acquired pneumonia (sCAP) is characterized by severe symptoms and a poor prognosis, especially with the recent global impact of novel coronavirus in recent years. The use of glucocorticoids in sCAP is currently a subject of debate. To evaluate the clinical efficacy and safety of glucocorticoids and provide guidance for their rational use in clinical practice, we conducted this study.
METHODS: We searched PubMed, Web of Science, and China National Knowledge Infrastructure using the following search terms: \"pneumonia\", \"pneumonias\", \"Pulmonary Inflammation\", \"Pulmonary Inflammations\", \"Lung Inflammation\", and \"Lung Inflammations\". The primary outcomes included mortality and the length of hospital stay. The secondary outcomes included the duration of mechanical ventilation, duration of vasoactive drug use, gastrointestinal bleeding, and multiple infections. The Cochrane Collaboration was used to assess the risk of bias of the included studies. Stata/MP14 was used for meta-analysis.
RESULTS: These studies contained information on 1252 patients who received glucocorticoids and 1280 patients who did not. Meta-analysis showed that there was no difference in terms of mortality [risk ratio (RR) = 0.93, 95% confidence interval (CI): 0.81-1.07, P > .05], gastrointestinal bleeding (RR = 1.38, 95% CI: 0.83-2.30, P < .05), multiple infections (RR = 1.17, 95% CI: 0.90-1.53, P > .05) and length of hospital stay (mean difference [MD] = -0.87, 95% CI: -2.35 to 0.61, P > .05) between the hormonal and nonhormonal groups. However, there was a significant difference in the duration of mechanical ventilation (MD = -1.54; 95% CI, -1.89 to -1.12, P < .05) and the duration of use of vasoactive drugs (MD = -14.09, 95% CI: -15.72 to -12.46, P < .05).
CONCLUSIONS: Glucocorticoids reduced the duration of mechanical ventilation duration and vasoactive drug use in sCAP patients without increasing the risk of adverse events including hyperglycemia and multiple infections. However, there was no significant difference in mortality or length of hospital stay in sCAP patients between glucocorticoid and non-glucocorticoid groups. Glucocorticoids could be recommended for patients with sCAP with respiratory failure or hemodynamic instability.