In Patients with Severe Pneumonia or ARDS, Corticosteroids Reduce Short-Term Mortality without Increasing Infections

Clinical Question: Does the use of systemic corticosteroids affect short-term mortality in adults with severe pneumonia or acute respiratory distress syndrome (ARDS)?

Background: While corticosteroids have been shown to reduce mortality in COVID-19 pneumonia, data are conflicting as to whether they are beneficial for patients with non-COVID-19 pneumonia or ARDS.

Study Design: Systematic review and meta-analysis

Setting: 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

Synopsis: 20 studies (15 for pneumonia and five for ARDS), including a total of 3,459 patients, were included in the analysis. The pooled study data suggested that the use of low-dose (3 mg/kg per day or less), short-course (15 days or less) steroids reduces short-term mortality in severe pneumonia (RR, 0.73; 95% CI, 0.57 to 0.93) and ARDS (RR, 0.77; CI, 0.61 to 0.99). Data on long-term mortality (beyond six months) were not available in this study. Steroid use did not result in a statistically significant increase in hospital-acquired infections or lead to an increase in secondary pneumonia.

This study is limited by heterogeneity between the studies analyzed in the meta-analysis, both when defining pneumonia severity and in the type and duration of steroid used. However, I² values assessing heterogeneity were generally acceptable.

Bottom Line: Adjunct, low-dose, short-course corticosteroids decreased short-term mortality in severe pneumonia and ARDS without increasing hospital-acquired infections.

Citation: Soumare A, et al. Systemic corticosteroids, mortality, and infections in pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis. Ann Intern Med. 2026;179(1):67-80. doi:10.7326/ANNALS-25-03055.

Dr. Nichols is a hospitalist in the departments of internal medicine and pediatrics at UC San Diego Health and the division of pediatrics at Rady Children’s Hospital, both in San Diego.