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

Summary

Pre-registered meta-analysis of 20 RCTs (n=3459) found that adjunct low-dose, short-course systemic corticosteroids probably reduce short-term mortality in severe pneumonia and ARDS. In severe pneumonia, mortality was reduced (RR 0.73, 95% CI 0.57–0.93); across conditions, hospital-acquired infections were not clearly increased.

Key Findings

• 20 RCTs (15 severe pneumonia, 5 ARDS) with 3459 participants met criteria after screening 16,831 records.
• In severe pneumonia, low-dose, short-course corticosteroids reduced short-term mortality (RR 0.73, 95% CI 0.57–0.93).
• Across severe pneumonia and ARDS, adjunct corticosteroids probably reduce short-term mortality and may have little or no effect on hospital-acquired infections.
• Corticosteroids may reduce secondary shock in severe pneumonia.

Clinical Implications

Consider adjunct low-dose, short-course corticosteroids in severe pneumonia and ARDS when not contraindicated, with monitoring for shock and infections. Heterogeneity in disease severity suggests individualized application and careful patient selection.

Limitations

• Heterogeneous pneumonia severity classification limited subgroup precision.
• Limited number of ARDS trials (5 studies) may reduce precision for ARDS-specific effects.

Future Directions

Define optimal dosing, duration, and patient selection in ARDS-specific RCTs; harmonize severity definitions; assess long-term outcomes and steroid-related adverse events.