Systemic Corticosteroids, Mortality, and Infections in Pneumonia and Acute Respiratory Distress Syndrome : A Systematic Review and Meta-analysis.

Summary

Across 20 RCTs (n=3459), adjunct systemic corticosteroids probably reduce short-term mortality in severe pneumonia (RR 0.73) and ARDS, and may reduce secondary shock in severe pneumonia, with little to no increase in hospital-acquired infections. Heterogeneity in pneumonia severity classifications limits subgroup precision.

Key Findings

• 20 RCTs (n=3459) met inclusion; 15 severe pneumonia, 5 ARDS.
• Low-dose, short-course corticosteroids probably reduce short-term mortality in severe pneumonia (RR 0.73, 95% CI 0.57–0.93).
• Adjunct steroids may reduce secondary shock in severe pneumonia.
• Across severe pneumonia and ARDS, steroids had little or no effect on hospital-acquired infections.

Clinical Implications

Consider low-dose, short-course systemic corticosteroids as adjunct therapy in severe pneumonia and ARDS to reduce short-term mortality and possibly secondary shock, with vigilance for infections though risk appears minimal.

Limitations

• Heterogeneous severity classifications and dosing regimens limited subgroup analyses.
• Relatively few ARDS trials reduce precision for ARDS-specific effects.

Future Directions

Prospective, adequately powered RCTs in ARDS with standardized severity definitions and dosing/duration protocols, and stratification by etiology and infection risk.