{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T12:30:34Z","timestamp":1783600234473,"version":"3.55.0"},"reference-count":63,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,6,24]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically reviewed randomised controlled trials (RCTs) comparing low-dose corticosteroids (\u2264400\u2009mg hydrocortisone-equivalent daily) to placebo or standard care in adults with severe pulmonary infections. The primary outcome was short-term mortality (\u226490 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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; I\u00b2=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 \u20130.78\u2009days (95%\u2009CI \u20131.46 to \u20130.10, 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 (\u22647\u2009days vs &gt;7\u2009days; OR: 0.69; 95%\u2009CI 0.53 to 0.89; p=0.039\u2009vs OR: 0.96; 95%\u2009CI 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%\u2009CI 0.54 to 0.98; p=0.034; number needed to treat: 28.10).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42024627881.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003934","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:55:36Z","timestamp":1783598136000},"page":"e003934","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Low-dose corticosteroids in severe pulmonary infection: a meta-analysis of randomised controlled trials"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3533-434X","authenticated-orcid":false,"given":"Joanne","family":"Lac","sequence":"first","affiliation":[{"name":"University College London Medical School, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sooyeon","family":"Han","sequence":"additional","affiliation":[{"name":"University College London Medical School, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmood","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Cardiology Department, Royal Free Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4531-3258","authenticated-orcid":false,"given":"Harvey","family":"Starey","sequence":"additional","affiliation":[{"name":"University College London Medical School, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soham","family":"Ganguly","sequence":"additional","affiliation":[{"name":"University College London Medical School, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Tett","sequence":"additional","affiliation":[{"name":"University College London Medical School, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwatosin","family":"Adeyemi","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J H","family":"Bray","sequence":"additional","affiliation":[{"name":"Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malik T","family":"Ahmad","sequence":"additional","affiliation":[{"name":"King\u2019s College London Department of Medical Education, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Provid\u00eancia","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics Research, University College London, London, UK"},{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, London, UK"},{"name":"Cardiology Department, Hospital da Luz Arr\u00e1bida, Vila Nova de Gaia, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"2026070904550706000_13.1.e003934.1","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofy313","article-title":"Sepsis in Intensive Care Unit Patients: Worldwide Data From the Intensive Care over Nations Audit","volume":"5","author":"Sakr","year":"2018","journal-title":"Open Forum Infect Dis"},{"key":"2026070904550706000_13.1.e003934.2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000194725.48928.3A"},{"key":"2026070904550706000_13.1.e003934.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.03.051"},{"key":"2026070904550706000_13.1.e003934.4","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.3390\/medicina57121356","article-title":"Factors Associated with ICU Admission in Patients with COVID-19: The GOL2DS Score","volume":"57","author":"Candelli","year":"2021","journal-title":"Medicina (B Aires)"},{"key":"2026070904550706000_13.1.e003934.5","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1007\/s00134-024-07489-2","article-title":"Pneumocystis pneumonia in intensive care: clinical spectrum, prophylaxis patterns, antibiotic treatment delay impact, and role of corticosteroids. 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