Efficacy of Corticosteroid Therapy in Severe Community-acquired Pneumonia: A Monocentric Single-blinded Randomized Placebo-controlled Trial from a Tertiary Care Center in North India

Aim and background: A dysregulated immune response can produce acute lung injury and worsen clinical status of patient by causing organ dysfunction and severe pneumonia. Modulating the immune response can improve the outcome of illness and avoid treatment failures. Glucocorticoids are well-known natural inhibitors of inflammation that can be used as an adjunctive treatment; however, their use still remains controversial. Hence, we planned this study to look at the efficacy of steroids to reduce treatment failure among patients of severe community-acquired pneumonia. Materials and methods: This was a monocentric, single-blinded, randomized placebo-controlled trial, conducted in 55 patients admitted in Government Medical College and Hospital Sector 32, Chandigarh. Participants were enrolled after they met all inclusion and exclusion criteria over a period of 12 months from January 2023 till December 2023. After enrollment, they were randomized through a 1:1 ratio to receive injection methylprednisolone 0.5 mg/kg q12h for 5 days and placebo along with standard antibiotic therapy. Outcomes included assessment of treatment failure, length of hospital stay, and mortality. The collected data was analyzed with Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, version 26.0. Results: In this study of 55 patients, 50 were included for analysis, with 3 leaving against medical advice and 2 withdrawing consent. Both groups had a mean age over 50 years. Initial hemodynamic stability was faster in intervention group (<italic>p</italic> = 0.025), but delayed stability was similar in both. Mortality during hospitalization (28 vs 40%; <italic>p</italic> = 0.37) and length of stay (6 days vs 8 days; <italic>p</italic> = 0.815) showed no difference. Early (57 vs 73%; <italic>p</italic> = 0.256) and late clinical stability (<italic>p</italic> = 0.572) were not significantly different. Likewise, early treatment failure (44 vs 64%; <italic>p</italic> = 0.156) and late treatment failure (18.18 vs 26.3%; <italic>p</italic> = 0.705) did not differ. Overall, primary and secondary outcomes did not show any statistically significant distinctions. Conclusion: In treating severe pneumonia, the use of an adjuvant corticosteroid was found to be statistically equivalent to using an antibiotic alone in this trial. Nonetheless, the intervention group showed a discernible improvement in clinical indicators and a decrease in complications, duration of hospital stay, mortality, and treatment failure rate, all of which remained below the threshold of statistical significance.