Outcome of Severe Pneumonia with Adjunct Corticosteroid Therapy at a Tertiary Care Teaching Hospital in Nepal

Abstract

Introduction: Severe pneumonia is a major cause of Emergency Room (ER) admission and morbidity and mortality worldwide. Early identification and adequate resuscitation in the initial hours after severe pneumonia is the challenge today for a better outcome. It is not clear whether corticosteroid (CS) as adjunct therapy in severe pneumonia improves the outcome. Therefore, this study was done to assess the benefit of adjunct CS therapy in the treatment of severe community acquired pneumonia (CAP).

Methods: This was a prospective, randomized controlled trial (RCT) conducted from May 2017 to April 2018 (12 months) in the ER, Intensive Care Unit (ICU), Intensive Critical Care Unit (ICCU), and Medical Intensive Care Unit (MICU) of Tribhuvan University Teaching hospital (TUTH) in patients with severe CAP {(Pneumonia Severity Index (PSI) grade IV and V)} in two groups of patients (with and without steroid as adjunct therapy).

Results: Clinical cure at 5 days in the steroid and no steroid group was 43.2% and 54.1% respectively (P =0.696); clinical cure at 28 days in the steroid and no steroid group was 75.9% and 79.3% (P = 0.753) respectively. Treatment failure was comparable in the steroid and no steroid group (45.9 % Vs 37.8 %; P = 0.696). Overall mortality in steroid and no steroid group was 32.5% and 27.5% respectively (Chi square = 0.238, p=0.626). There was no statistically significant difference in the time to clinical stability (ttcs) between steroid and no steroid group (mean ttcs: 5.22 days Vs 5.78 days, SD: 3.106 Vs 3.671, p value: 0.521). The mean length of stay (LOS) in hospital for steroid group: 10.26 days, mean LOS for no steroid group: 11.26 days; p value: 0.438).

Conclusion: Among patients with severe pneumonia, adjunct corticosteroid therapy did not result in lower 48 hours, 5 days, and 28-days mortality. Hence, it was found that adjunct corticosteroid therapy is not beneficial in patients with severe pneumonia.