Related Experiment Video
Updated: Jan 9, 2026
Experimental Model to Evaluate Resolution of Pneumonia
Published on: February 17, 2023
Systemic Corticosteroids, Mortality, and Infections in Pneumonia and Acute Respiratory Distress Syndrome : A
Alice Soumare1, Thomas Kapfer1, Thomas Botrel1
1AP-HP, Hôpital La Pitié Salpêtrière, DMU DREAM, Department of Anesthesiology and Critical Care, Paris, France (A.S., T.K., T.B., P.-L.B., J.-M.C.).
Background:
The benefit-risk profile of systemic corticosteroids in non-COVID-19 pneumonia and acute respiratory distress syndrome (ARDS) remains debated.
Purpose:
To assess corticosteroid effects on mortality and infection-related complications in adults with severe pneumonia or ARDS.
Data Sources:
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform through September 2025.
Study Selection:
Randomized controlled trials comparing systemic corticosteroids with placebo and usual care. Primary analysis: severe pneumonia or ARDS with corticosteroids 3 mg/kg-1 of body weight per day-1 or less (prednisone-equivalent) for 15 days or less, initiated within 7 days.
Data Extraction:
Paired reviewers; consensus for disagreements.
Data Synthesis:
From 16 831 screened records, 20 studies (15 severe pneumonia, 5 ARDS) including 3459 participants met criteria. Low-dose, short-course corticosteroids probably reduce short-term mortality in severe pneumonia (15 studies, 2445 participants; risk ratio [RR], 0.73 [95% CI, 0.57 to 0.93]; I 2 = 14%; moderate certainty) and ARDS (5 studies, 1014 participants; RR, 0.77 [CI, 0.61 to 0.99]; I 2 = 23%; moderate certainty). Corticosteroids may reduce secondary shock in severe pneumonia (9 studies, 1690 participants; RR, 0.49 [CI, 0.26 to 0.92]; I 2 = 55%; low certainty). They probably result in little to no difference in hospital-acquired infections (severe pneumonia: 7 studies, 1665 participants; RR, 0.99 [CI, 0.82 to 1.20]; I 2 = 0%; moderate certainty; ARDS: 4 studies, 677 participants; RR, 0.97 [CI, 0.59 to 1.59]; I 2 = 0%; low certainty) or secondary pneumonia (severe pneumonia: 4 studies, 1011 participants; RR, 0.96 [CI, 0.66 to 1.39]; I 2 = 0%; ARDS: 4 studies, 677 participants; RR, 0.88 [CI, 0.43 to 1.79]; I 2 = 0%; both low certainty). Evidence is very uncertain for catheter-related and bloodstream infections. Long-term mortality evidence is very uncertain for severe pneumonia.
Limitation:
Heterogeneous pneumonia severity classification limiting subgroup precision.
Conclusion:
In severe pneumonia and ARDS, adjunct corticosteroids probably reduce short-term mortality. In severe pneumonia, they may reduce secondary shock. In both conditions, corticosteroids may have little or no effect on hospital-acquired infections.
Primary Funding Source:
None. (PROSPERO: CRD42024536301).
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