Systemic Corticosteroids, Mortality, and Infections in Pneumonia and Acute Respiratory Distress Syndrome

BACKGROUND: The benefit-risk profile of systemic corticosteroids in non-COVID-19 pneumonia and acute respiratory distress syndrome (ARDS) remains debated. PURPOSE: To assess corticosteroid effects on mortality and infection-related complications in adults with severe pneumonia or ARDS. DATA SOURCES: 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. STUDY SELECTION: or less (prednisone-equivalent) for 15 days or less, initiated within 7 days. DATA EXTRACTION: Paired reviewers; consensus for disagreements. DATA SYNTHESIS: = 0%; both low certainty). Evidence is very uncertain for catheter-related and bloodstream infections. Long-term mortality evidence is very uncertain for severe pneumonia. LIMITATION: Heterogeneous pneumonia severity classification limiting subgroup precision. CONCLUSION: In severe pneumonia and ARDS, adjunct corticosteroids probably reduce short-term mortality. In severe pneumonia, they may reduce secondary shock. In both conditions, corticosteroids may have little or no effect on hospital-acquired infections. PRIMARY FUNDING SOURCE: None. (PROSPERO: CRD42024536301).