At what Pneumonia Severity Index (PSI)/Pneumonia Outcomes Research Team (PORT) score would you administer corticosteroids to a patient with pneumonia?

From the Guidelines

Corticosteroids should be administered to patients with community-acquired pneumonia and a Pneumonia Severity Index (PSI) score of class IV or V (>90 points) or a CURB-65 score ≥3, as these patients are considered to have severe pneumonia and may benefit from adjunctive corticosteroid therapy. The use of corticosteroids in patients with community-acquired pneumonia (CAP) is a topic of ongoing debate, with some studies suggesting a mortality benefit in patients with severe CAP 1. However, the 2019 guidelines from the American Thoracic Society and Infectious Diseases Society of America recommend against the routine use of corticosteroids in adults with nonsevere CAP, and suggest against their use in adults with severe CAP, except in cases of refractory septic shock 1. In patients with severe CAP, defined as a PSI score of class IV or V (>90 points) or a CURB-65 score ≥3, adjunctive corticosteroid therapy may be beneficial in reducing mortality, shortening hospital stay, and preventing the need for mechanical ventilation 1. The typical regimen is intravenous methylprednisolone 0.5 mg/kg every 12 hours or dexamethasone 6 mg daily for 5-7 days. Some key points to consider when using corticosteroids in patients with CAP include:

• The decision to use corticosteroids should be individualized, taking into account the severity of pneumonia and the patient's overall clinical condition.
• Corticosteroids should be used cautiously in patients with certain comorbidities, such as uncontrolled diabetes or active infections like tuberculosis.
• Steroid therapy should be initiated early in the course of treatment, ideally within 36 hours of hospital admission, and should be accompanied by appropriate antibiotic therapy based on likely pathogens.
• The use of corticosteroids in patients with viral CAP, such as influenza, may be associated with increased mortality, and should be avoided unless there is a clear indication for their use 1.

From the Research

Pneumonia Severity Index (PSI)/Pneumonia Outcomes Research Team (PORT) Score and Corticosteroid Administration

The decision to administer corticosteroids to a patient with pneumonia is based on various factors, including the severity of the disease.

• The PSI/PORT score is a widely used tool to assess the severity of community-acquired pneumonia (CAP) and predict patient outcomes 2, 3, 4, 5.
• However, there is no specific PSI/PORT score threshold mentioned in the provided studies for administering corticosteroids to patients with pneumonia.
• The studies focus on the prognostic performance of different scoring systems, including PSI/PORT, CURB-65, and SCAP, in predicting disease severity and mortality in patients with CAP or COVID-19 pneumonia 3, 4, 6.
• The use of corticosteroids in pneumonia treatment is not directly addressed in the provided evidence.

Corticosteroid Administration in Pneumonia

• There is no clear guidance on the specific PSI/PORT score threshold for administering corticosteroids to patients with pneumonia based on the provided studies.
• The decision to use corticosteroids in pneumonia treatment is typically based on clinical judgment and patient-specific factors, rather than a specific scoring system threshold.
• Further research is needed to determine the optimal PSI/PORT score threshold for corticosteroid administration in patients with pneumonia.

Scoring Systems for Pneumonia Severity

• The PSI/PORT score is a useful tool for assessing pneumonia severity and predicting patient outcomes 2, 3, 4, 5.
• Other scoring systems, such as CURB-65 and SCAP, are also used to evaluate pneumonia severity and predict mortality 3, 4, 6.
• The choice of scoring system may depend on the specific clinical context and patient population.