Oral Dexamethasone in CAP Reduces Length of Stay, But May Increase Readmissions

Treatment with oral dexamethasone reduced length of stay (LOS) and intensive care unit (ICU) admissions in adults hospitalized with community-acquired pneumonia (CAP), according to study results in the European Respiratory Journal.

In the Santeon-CAP clinical trial (ClinicalTrials.gov Identifier: NCT01743755), researchers randomly assigned immunocompetent adult patients with CAP from 4 non-academic teaching hospitals in the Netherlands to either once-daily 6 mg oral dexamethasone (n=203) or placebo (n=198) for 4 days. The randomization protocol was stratified by severity of CAP based on pneumonia severity index (PSI) classifications 1 through 3 (non-severe CAP) and 4 through 5 (severe CAP). The study’s primary outcome was LOS, while secondary outcomes included ICU admission and all-cause mortality within 30 days of admission.

Approximately 39% (n=156) of patients in the study were classified as having severe CAP, and the mean PSI score for all patients was 81. The median LOS was significantly shorter in the group of patients treated with oral dexamethasone (4.5 [95% CI, 4.0-5.0] vs 5.0 days [95% CI, 4.6-5.4]; P =.033). In terms of the 2 CAP severity subgroups, there were no differences in LOS between treatment and placebo.

Treatment with dexamethasone was associated with a significantly lower secondary ICU admission rate compared with placebo (3% vs 7%, respectively; P =.030). The 30-day mortality rate did not differ between the dexamethasone and placebo groups (2% vs 4%, respectively; risk ratio [RR], 0.56; 95% CI, 0.17-1.87; P =.34). Hospital readmission tended to be higher in the dexamethasone group (10% vs 5%; P =.051). In addition, the rate of hyperglycemia was higher in the dexamethasone group (7% vs 1%; RR, 13.7; 1.81-103; P =.001).

Limitations of the study included its premature termination because of slow inclusion rates as well as the exclusion of patients admitted directly to an ICU, which may affect the generalizability of the findings.

The investigators concluded that “the benefits of dexamethasone should be weighed against the risks,” emphasizing that while “a 10% reduction in LOS and reduction in ICU admissions seems to be a considerable benefit for patients,” this benefit “should be weighed against a possible rise in readmissions.”

Reference

Wittermans E, Vestjens SMT, Spoorenberg SMC, et al; for the Santeon-CAP study group. Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia: a randomised clinical trial. Published online January 21, 2021. Eur Respir J. doi:10.1183/13993003.02535-2020