{
  "abstract": "Purpose Pulmonary infections are one of the leading causes of intensive care unit (ICU) admission and contribute to high mortality rates. This paper aimed to determine the effect of low-dose corticosteroids on outcomes in patients with severe pulmonary infections, including coronavirus disease of 2019, community-acquired pneumonia (CAP), pneumocystis pneumonia, sepsis, septic shock, and acute respiratory distress syndrome.Methods We systematically reviewed randomised controlled trials (RCTs) comparing low-dose corticosteroids (≤400 mg hydrocortisone-equivalent daily) to placebo or standard care in adults with severe pulmonary infections. The primary outcome was short-term mortality (≤90 days). Secondary outcomes included 28-day mortality, 30-day mortality, number of patients with at least one serious adverse event, length of hospital stay and ICU stay.Results We analysed twelve RCTs including 4622 patients and 1203 events. The pooled OR showed a short-term mortality benefit: 0.83 (95% CI 0.70 to 0.98; p=0.029; I²=2.0%; number needed to treat: 37.84; Grading of Recommendations Assessment, Development and Evaluation (GRADE): low certainty). There was a reduction in length of ICU stay in patients with CAP, with a pooled mean difference of –0.78 days (95% CI –1.46 to –0.10, p=0.025). The use of corticosteroids did not significantly affect the length of hospital stay or severe adverse events. A significant difference remained in longer courses of steroids, whereas shorter courses had no significant difference (≤7 days vs >7 days; OR: 0.69; 95% CI 0.53 to 0.89; p=0.039 vs OR: 0.96; 95% CI 0.813 to 1.14; p=0.67; subgroup differences: p=0.03). Subgroup analyses in patients with CAP showed a significant benefit in short-term mortality (OR: 0.72, 95% CI 0.54 to 0.98; p=0.034; number needed to treat: 28.10).Conclusion We found that low-dose corticosteroids significantly reduce 90-day mortality in severe CAP, although evidence for their benefit in other severe pulmonary infections and at shorter follow-up intervals remains inconclusive.PROSPERO registration number CRD42024627881.",
  "authors": [
    {
      "affiliations": [
        "University College London Medical School, London, UK"
      ],
      "name": "Joanne Lac"
    },
    {
      "affiliations": [
        "University College London Medical School, London, UK"
      ],
      "name": "Sooyeon Han"
    },
    {
      "affiliations": [
        "Cardiology Department, Royal Free Hospital, London, UK"
      ],
      "name": "Mahmood Ahmad"
    },
    {
      "affiliations": [
        "University College London Medical School, London, UK"
      ],
      "name": "Harvey Starey"
    },
    {
      "affiliations": [
        "University College London Medical School, London, UK"
      ],
      "name": "Soham Ganguly"
    },
    {
      "affiliations": [
        "University College London Medical School, London, UK"
      ],
      "name": "Michael Tett"
    },
    {
      "affiliations": [
        "Pharmacy Department, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK"
      ],
      "name": "Oluwatosin Adeyemi"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK"
      ],
      "name": "Jonathan J H Bray"
    },
    {
      "affiliations": [
        "King’s College London Department of Medical Education, London, UK"
      ],
      "name": "Malik T Ahmad"
    },
    {
      "affiliations": [
        "Institute of Health Informatics Research, University College London, London, UK",
        "Barts Heart Centre, St Bartholomew’s Hospital, London, UK",
        "Cardiology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal"
      ],
      "name": "Rui Providência"
    }
  ],
  "title": "Low-dose corticosteroids in severe pulmonary infection: a meta-analysis of randomised controlled trials",
  "uid": "f7feb397-d5e2-5ed6-8f61-66c47e9c864e"
}