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Currently, there is no clear evidence to support the use of high-dose glucocorticoids for treating CAP. On the contrary, there is a tentative guideline suggesting low-dose glucocorticoids for CAP and most likely intravenous methylprednisolone (1 to 2mg/kg per day for 3 days). Our results showed that low-dose glucocorticoid can reduce the morbidity of CAP, especially in patients with high risks of death. Our findings might be misleading for some patients that prednisone is generally administered at 1mg/kg per day for 5 days. Actually, a study by Fudalej et al. had investigated the optimal dose and duration of methylprednisolone in CAP patients. The authors reported that the mortality rates and length of hospitalization were not significantly different between patients who received 3 days of intravenous methylprednisolone (1mg/kg per day) and 4 days of intravenous methylprednisolone (0.5mg/kg per day) [ 9 ]. From the dose-response data of short-term intravenous methylprednisolone for CAP, the authors suggested the optimal dose of methylprednisolone for CAP was 0.5mg/kg per day for 3 days. From the long-term results of low-dose intravenous methylprednisolone for CAP, the authors suggested that the optimal duration of methylprednisolone was 4 days. Besides the optimal doses and durations of glucocorticoid in CAP, other therapy of CAP also need to be focused on in future study. The primary endpoint was 90-day mortality, but the patients enrolled in this study did not present a risk of death. It is possible that a risk of death can be detected in future studies. Also, it has been suggested that the patients may be less likely to receive the most appropriate empirical therapy, which might lead to the selection bias.
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