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Vol. 53. Issue 2.
Pages 55-61 (February 2017)
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Vol. 53. Issue 2.
Pages 55-61 (February 2017)
Original Article
Adjunctive Corticosteroids for Pneumocystis jirovecii Pneumonia in Non-HIV-Infected Patients: A Systematic Review and Meta-Analysis of Observational Studies
Tratamiento complementario con corticoides en la neumonía por Pneumocystis jirovecii en pacientes no infectados por VIH: revisión sistemática y metanálisis de los estudios observacionales
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Yuji Fujikuraa,
Corresponding author
fujikura@ndmc.ac.jp

Corresponding author.
, Toshie Manabeb,c, Akihiko Kawanaa, Shigeru Kohnod
a Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
b Department of Pulmonary Medicine, University of Tsukuba, Graduate School of Comprehensive Human Science, Ibaraki, Japan
c Department of Hygiene and Public Health, Teikyo University, School of Medicine, Tokio, Japan
d Nagasaki University, Nagasaki, Japan
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Tables (2)
Table 1. Characteristics of Observational Studies Included.
Table 2. Treatment Profiles of Patients in Studies.
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Abstract
Introduction

The clinical benefits of adjunctive corticosteroids for Pneumocystis jirovecii pneumonia in patients not infected with the human immunodeficiency virus (HIV) has not been evaluated by meta-analysis.

Methods

We conducted a systematic review of published studies describing the effects of adjunctive corticosteroids on outcome in non-HIV P. jirovecii pneumonia patients. Two investigators independently searched the PubMed and Cochrane databases for eligible articles written in English. A meta-analysis was performed using a random-effects model for measuring mortality as the primary outcome, and the need for intubation or mechanical ventilation as the secondary outcome.

Results

Seven observational studies were eligible. In these studies, adjunctive corticosteroids did not affect mortality in non-HIV patients (odds ratio [OR] 1.26; 95% CI 0.60–2.67) and there was no beneficial effect in patients with severe hypoxemia (PaO2 <70mmHg) (OR 0.90; 95% CI 0.44–1.83). No significant effect on the secondary outcome was observed (OR 1.34; 95% CI 0.44–4.11).

Conclusions

Although the studies were observational, meta-analysis showed that adjunctive corticosteroids did not improve the outcome of P. jirovecii pneumonia in non-HIV patients. The results warrant a randomized controlled trial.

Keywords:
Corticosteroids
Immunocompromised host
Pneumocystis pneumonia
Pneumocystis jirovecii
Review
Resumen
Introducción

Los beneficios clínicos del tratamiento complementario con corticoides de la neumonía por Pneumocystis jirovecii (P. jirovecii) en pacientes no infectados por el virus de la inmunodeficiencia humana (VIH) no se han evaluado mediante metanálisis.

Métodos

Realizamos una revisión sistemática de los estudios publicados que describen los efectos del tratamiento complementario con corticoides sobre la evolución de pacientes con neumonía por P. jirovecii no infectados por VIH. Dos investigadores hicieron búsquedas independientes de artículos elegibles escritos en inglés en las bases de datos PubMed y Cochrane. Se efectuó un metanálisis con un modelo de efectos aleatorios para determinar la mortalidad como variable principal, y la necesidad de intubación o ventilación mecánica como variable secundaria.

Resultados

Siete estudios observacionales resultaron elegibles. En ellos, el tratamiento complementario con corticoides no afectó a la mortalidad en los pacientes no infectados por VIH (odss ratio [OR] 1,26; IC 95% 0,60–2,67) y no tuvo ningún efecto beneficioso para los pacientes con hipoxemia intensa (PaO2<70mmHg) (OR 0,90; IC 95% 0,44–1,83). No se observó ningún efecto significativo sobre la variable secundaria (OR 1,34; IC 95% 0,44–4,11).

Conclusiones

Aunque los estudios eran observacionales, el metanálisis mostró que el tratamiento complementario con corticoides no mejoraba la evolución de los pacientes con neumonía por P. jirovecii no infectados por VIH. Estos resultados justifican la realización de un ensayo controlado aleatorizado.

Palabras clave:
Corticoides
Huésped inmunocomprometido
Neumonía por Pneumocystis
Pneumocystis jirovecii
Revisión

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