No Mortality Advantage for Higher-Dose Steroids in Pneumonia
This network meta-analysis clarifies that once corticosteroids are given for community-acquired pneumonia, escalating the dose does not measurably lower short-term mortality.
corticosteroidsdexamethasonecommunity-acquired pneumoniaCAPnetwork meta-analysiscritical caresepsismortalitydose comparisonCritical Care / ICU
Background Information
Lower and higher corticosteroid doses both reduce pneumonia mortality.
Corticosteroids are used to improve outcomes in patients hospitalized with community-acquired pneumonia (CAP), but optimal dosing is unclear. Both higher-dose and lower-dose corticosteroids reduced short-term mortality compared to placebo: higher-dose risk ratio (RR) 0.83 and lower-dose RR 0.84. No significant difference was found between doses. The study suggests lower-dose corticosteroids may be sufficient for CAP, as no significant mortality difference was found compared to higher doses. Results are limited by low confidence in dose comparisons. Both lower and higher doses of corticosteroids reduce short-term mortality in CAP with no clear advantage between dosing regimens.
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Authors:Ouyang Y, Lai J, Wang P, Yuan X, Wang H, Xiang Z, Xiao Y, He J, Wan J, Fang F, Zhang Y, Jia L
Citation:Ouyang Y, Lai J, Wang P, et al. Efficacy of higher-dose versus lower-dose corticosteroids in community-acquired pneumonia: a systematic review and network meta-analysis. Critical care (London, England). 2026;30(1). doi:10.1186/s13054-026-06185-5