C28-17 Corticosteroids for Severe Hospitalized Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis

Abstract Introduction Corticosteroids have been evaluated as an adjunctive therapy for severe community-acquired pneumonia (CAP), with recent trials generating mixed results and continued uncertainty in clinical practice. The CAPE COD trial demonstrated improved outcomes, while the REMAP- CAP Corticosteroid Domain found limited benefit. We conducted an updated systematic review and meta-analysis to assess the effect of corticosteroids on mortality and need for mechanical ventilation in adults with severe CAP. Methods We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials from inception through 2025. Randomized controlled trials (RCTs) evaluating corticosteroids versus placebo in hospitalized adults with severe CAP were included. Two reviewers independently screened studies and extracted data. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. Primary outcomes were all-cause mortality and need for mechanical ventilation. Results Eighteen trials (n = 4261) met inclusion criteria. Corticosteroids were associated with a non-significant reduction in mortality (RR 0.84; 95% CI 0.67- 1.05; I²= 28%) (top figure). However, corticosteroids significantly reduced the need for intubation and mechanical ventilation (RR 0.57; 95% CI 0.45- 0.72; I²= 0%) (bottom figure). Conclusion Among adults hospitalized with severe CAP, adjunctive corticosteroids were associated with a reduced need for mechanical ventilation but did not significantly impact mortality. Variability in patient selection and dosing strategies highlights the need for further high-quality trials to clarify clinical benefit. This abstract is funded by: None