Low-Dose Corticosteroids for Critically Ill Adults With Severe Pulmonary Infections: A Review

Low-Dose Corticosteroids for Critically Ill Adults With Severe Pulmonary Infections: A Review

Authors: Romain Pirracchio, Balasubramanian Venkatesh, Matthieu Legrand

Published in: JAMA, June 13, 2024

Conclusions and Relevance: Low-dose corticosteroids improve survival rates in severe respiratory infections and are particularly beneficial in conditions like severe COVID-19, severe community-acquired pneumonia, and Pneumocystis pneumonia in HIV patients. They are also advantageous in managing complications such as septic shock and ARDS. This review supports their use while noting the potential for significant adverse effects.

Observations: This review synthesizes data from several clinical trials and meta-analyses to evaluate the efficacy of low-dose corticosteroids in these severe conditions. "Low-dose" is defined as ≤400 mg of hydrocortisone equivalent per day.

• COVID-19: A significant trial involving 6,425 patients showed that dexamethasone (6 mg daily for 10 days) reduced 28-day mortality rates significantly among those requiring respiratory support.
• Community-Acquired Pneumonia: A meta-analysis of 1,689 ICU patients indicated that a similar low-dose regimen decreased 30-day mortality compared to placebo.
• Pneumocystis Pneumonia in HIV: Analysis revealed that low-dose corticosteroids halved the mortality rate compared to placebo.
• Septic Shock and ARDS: Subgroup analyses and additional meta-analyses supported the use of low-dose corticosteroids in reducing mortality in these severely ill patient groups.

Adverse Effects: While beneficial, corticosteroids can cause significant side effects like hyperglycemia, gastrointestinal bleeding, neuropsychiatric issues, and increased risk of infections.