Abstract
Background Adjunctive intravenous corticosteroid treatment has been shown to reduce length of stay (LOS) in adults hospitalised with community-acquired pneumonia (CAP). We aimed to assess the effect of oral dexamethasone on LOS and whether this effect is disease severity dependent.
Methods In this multicentre, stratified randomised, double-blind, placebo-controlled trial, immunocompetent adults with CAP were randomly assigned (1:1 ratio) to receive oral dexamethasone (6 mg once daily) or placebo for 4 days in four teaching hospitals in the Netherlands. Randomisation (blocks of four) was stratified by CAP severity (pneumonia severity index class I–III and IV–V). The primary outcome was LOS.
Results Between December 2012 and November 2018, 401 patients were randomised to receive dexamethasone (n=203) or placebo (n=198). Median LOS was shorter in the dexamethasone group (4.5 days, 95% CI 4.0–5.0 days) than in the placebo group (5.0 days, 95% CI 4.6–5.4 days; p=0.033). Within both CAP severity subgroups, differences in LOS between treatment groups were not statistically significant. The secondary ICU admission rate was lower in the dexamethasone arm (5 (3%) versus 14 (7%); p=0.030); 30-day mortality did not differ between groups. In the dexamethasone group the rate of hospital readmission tended to be higher (20 (10%) versus 9 (5%); p=0.051) and hyperglycaemia (14 (7%) versus 1 (1%); p=0.001) was more prevalent.
Conclusion Oral dexamethasone reduced LOS and ICU admission rate in adults hospitalised with CAP. It remains unclear for which patients the risk–benefit ratio is optimal.
Abstract
Adjunctive treatment with oral dexamethasone in adults hospitalised with community-acquired pneumonia (CAP) reduced length of stay and ICU admission rate. However, it remains unclear for which CAP subgroup the risk–benefit ratio is optimal. https://bit.ly/35tXfPX
Footnotes
Members of the Santeon-CAP Study Group: Willem Jan W. Bos (St Antonius Hospital, Nieuwegein, The Netherlands), Ewoudt M.W. van de Garde (St Antonius Hospital, Nieuwegein, The Netherlands and University of Utrecht, Utrecht, The Netherlands), Jan C. Grutters (St Antonius Hospital Nieuwegein, The Netherlands and University Medical Center Utrecht, Utrecht, The Netherlands), Ger T. Rijkers (Roosevelt Academy, Middelburg, The Netherlands), Douwe H. Biesma (St Antonius Hospital, Nieuwegein, The Netherlands), G. Paul Voorn (St Antonius Hospital, Nieuwegein, The Netherlands), Simone M.C. Spoorenberg (University Medical Center Utrecht, Utrecht, The Netherlands), Stefan M.T. Vestjens (St Antonius Hospital, Nieuwegein, The Netherlands), Esther Wittermans (St Antonius Hospital, Nieuwegein, The Netherlands), Frank W.J.M. Smeenk (Catharina Hospital, Eindhoven, The Netherlands), Arnoud F. Aldenkamp (Catharina Hospital, Eindhoven, The Netherlands), Rob Janssen (Canisius Wilhelmina Hospital, Nijmegen, The Netherlands), Charlotte A. van Ruitenbeek (Canisius Wilhelmina Hospital, Nijmegen, The Netherlands), Willem L. Blok (OLVG, Amsterdam, The Netherlands), Paul Bresser (OLVG, Amsterdam, The Netherlands), Joris W.T. van Enschot (Maxima Medical Center, Veldhoven, The Netherlands) and Hester A.A. Zegers (Hospital Bernhoven, Uden, The Netherlands).
This article has supplementary material available from erj.ersjournals.com
This study is registered at ClinicalTrials.gov with identifier number NCT01743755. Individual participant data that underlie the results reported in this article after de-identification, a dictionary defining each field in the dataset and the study protocol will be made available after approval of the proposal by the Santeon-CAP Study Group. Requests should be directed to w.bos{at}antoniusziekenhuis.nl (on behalf of the Santeon-CAP Study Group) along with an analysis proposal; data requestors will need to sign a data access agreement.
Author contributions: W.J.W. Bos, S.M.C. Spoorenberg, J.C. Grutters and E.M.W. van de Garde designed the study and wrote the study protocol. S.M.T. Vestjens, S.M.C. Spoorenberg and E. Wittermans were responsible for recruitment and follow-up of the participants and study coordination. W.J.W. Bos, J.C. Grutters, F.W.J.M. Smeenk, W.L. Blok and R. Janssen were the principal investigators in the participating hospitals. G.P. Voorn was responsible for microbiological data. E.M.W. van de Garde supervised the packaging and labelling of study medication, and contributed to the data analysis. E. Wittermans analysed the data and wrote the first draft of the manuscript. W.J.W. Bos, J.C. Grutters, G.T. Rijkers, E.M.W. van de Garde, G.P. Voorn, S.M.T. Vestjens, S.M.C. Spoorenberg, F.W.J.M. Smeenk, W.L. Blok and R. Janssen critically revised the manuscript. All authors had access to the data and contributed substantially to the submitted manuscript.
Conflict of interest: E. Wittermans has nothing to disclose.
Conflict of interest: S.M.T. Vestjens has nothing to disclose.
Conflict of interest: S.M.C. Spoorenberg has nothing to disclose.
Conflict of interest: W.L. Blok has nothing to disclose.
Conflict of interest: J.C. Grutters has nothing to disclose.
Conflict of interest: R. Janssen has nothing to disclose.
Conflict of interest: G.T. Rijkers has nothing to disclose.
Conflict of interest: F.W.J.M. Smeenk has nothing to disclose.
Conflict of interest: G.P. Voorn has nothing to disclose.
Conflict of interest: E.M.W. van de Garde has nothing to disclose.
Conflict of interest: W.J.W. Bos reports grants from Zilveren Kruis Insurance, outside the submitted work.
Support statement: This work was supported by St Antonius Hospital, St Antonius Research Fund via an earmarked donation from Verwelius Construction Corporation. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received July 3, 2020.
- Accepted December 27, 2020.
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