Low-dose corticosteroids may reduce mortality in critically ill adults with severe pulmonary infections such as COVID-19 and pneumonia, according to a recent review published in JAMA.
COVID-19, community-acquired bacterial pneumonia (CAP), and Pneumocystis pneumonia, are associated with high mortality rates and can lead to septic shock and acute respiratory distress syndrome (ARDS). Previous research has indicated that corticosteroids may reduce the immune response to infections and improve patient outcomes.
In the new review, investigators looked at a randomized clinical trial of 6,425 COVID-19 patients; in this population, dexamethasone at 6 mg daily for 10 days was associated with a reduction in 28-day mortality vs. standard care among those who required mechanical ventilation (29% vs. 41%) or supplemental oxygen (23% vs. 26%).
Similarly, a meta-analysis of 1,689 ICU patients with severe bacterial CAP found low-dose hydrocortisone given at 400 mg or less for 8 days or less was linked to a reduced 30-day mortality compared with placebo (10% vs. 16%).
Another meta-analysis of 6 randomized trials found that low-dose corticosteroids were associated with lower mortality rates in patients with HIV and moderate-to-severe Pneumocystis pneumonia (13% vs. 25%).
For patients with ARDS caused by various conditions, a meta-analysis of 8 studies that included a total population of nearly 1,100 patients found that low-dose corticosteroids were associated with decreased in-hospital mortality (34% vs. 45%).
Reported adverse effects of low-dose corticosteroids included hyperglycemia, gastrointestinal bleeding, neuropsychiatric disorders, muscle weakness, hypernatremia, and secondary infections.
The investigators noted while the agents significantly lowered 28-day mortality in patients requiring supplemental oxygen or mechanical ventilation, they did not affect mortality among patients with COVID-19 who were not on supplemental oxygen. In fact, the authors noted, "outpatients with COVID-19 and hospitalized patients who do not require supplemental oxygen should not be treated with corticosteroids."
Low-dose corticosteroid treatment is linked to reduced mortality in patients with severe COVID-19, severe CAP, and moderate-to-severe Pneumocystis pneumonia in patients with HIV, concluded the study authors. Additionally, the agents may also benefit critically ill patients with respiratory infections who have septic shock, ARDS, or both.
Full disclosures can be found in the original study.