Low-dose corticosteroids reduce 90-day mortality in adults with severe community-acquired pneumoniaLow dose steroids may lower death rates in severe lung infections

BMJ open respiratory research Published August 18, 2026 Study authors: Lac Joanne, Han Sooyeon, Ahmad Mahmood, Starey Harvey, Ganguly Soham, Tett Michael, Adeyemi Oluwatos… PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider low-dose corticosteroids (>7 days) to reduce 90-day mortality in adults with severe community-acquired pneumonia.

This meta-analysis evaluated the impact of low-dose corticosteroids (≤400 mg hydrocortisone-equivalent daily) on outcomes in 4,622 adults with severe pulmonary infections, including community-acquired pneumonia (CAP), sepsis, and ARDS. The study found a significant reduction in short-term mortality (≤90 days) for the overall population (OR 0.83; 95% CI 0.70 to 0.98; p=0.029). Specifically, patients with CAP showed an even greater reduction in short-term mortality (OR 0.72; 95% CI 0.54 to 0.98; p=0.034).

Regarding treatment duration, longer courses of steroids (>7 days) were associated with a significant reduction in mortality (OR 0.69; 95% CI 0.53 to 0.89; p=0.039), whereas shorter courses (≤7 days) showed no significant difference in mortality (OR 0.96; 95% CI 0.813 to 1.14; p=0.67). Additionally, a reduction in ICU stay duration was observed for patients with CAP (-0.78 days; 95% CI -1.46 to -0.10; p=0.025).

The authors note that the evidence for mortality benefit in infections other than CAP and at shorter follow-up intervals remains inconclusive. The certainty of evidence for short-term mortality benefit is graded as low. Clinical application is most supported for severe CAP, where a significant reduction in 90-day mortality was observed.

How this fits prior evidence

This meta-analysis addresses the management of severe pulmonary infections. It builds upon existing knowledge regarding severe community-acquired pneumonia (CAP), specifically confirming that oral amoxicillin or amoxicillin-clavulanate is non-inferior to intravenous treatment in pediatric patients. While this study focuses on adult populations, it provides specific evidence for the use of low-dose corticosteroids to reduce 90-day mortality in severe CAP.

When a patient suffers from a severe lung infection, every day counts. New analysis of data from over 4,600 adults shows that using low-dose corticosteroids—a type of steroid medication—can help reduce the risk of death within 90 days for those with serious conditions like community-acquired pneumonia.

The study specifically looked at patients receiving a low dose of hydrocortisone or similar steroids. The results showed that these patients were less likely to die in the short term compared to those who did not receive them. For those with community-acquired pneumonia, the treatment also helped shorten the amount of time spent in the intensive care unit.

While the findings are promising for certain lung infections, researchers note some uncertainty. The evidence is currently less clear for other types of severe pulmonary infections and for shorter follow-up periods. Additionally, the study suggests that longer courses of steroids lasting more than seven days showed a stronger link to lower mortality than shorter courses.

What this means for you:

Low-dose corticosteroids can reduce 90-day death rates for adults with severe lung infections like pneumonia.

Common questions

Who does this treatment help?

This finding specifically relates to adults suffering from severe pulmonary infections. This includes conditions such as community-acquired pneumonia, sepsis, septic shock, and acute respiratory distress syndrome.

How long should the steroid treatment last to be effective?

The data suggests a difference in outcomes based on timing. Patients on longer courses of steroids lasting more than 7 days showed a significant reduction in mortality, while shorter courses of 7 days or less did not show a significant difference.

Are there any safety concerns with using these steroids?

The study found no significant effect on the number of patients experiencing at least one serious adverse event when using low-dose corticosteroids for these infections.

Study Details

Study typeMeta analysis

Sample sizen = 4,622

EvidenceLevel 1

PublishedJul 2026

PMID42425738

View Original 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.

Low-dose corticosteroids reduce 90-day mortality in adults with severe community-acquired pneumoniaLow dose steroids may lower death rates in severe lung infections

How this fits prior evidence

Common questions

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Low-dose corticosteroids reduce 90-day mortality in adults with severe community-acquired pneumoniaLow dose steroids may lower death rates in severe lung infections

How this fits prior evidence

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