Assessment of Corticosteroids in Community-Acquired Pneumonia

Introduction: Community-acquired pneumonia(CAP) is a leading cause of morbidity and mortality worldwide. While recent guidelines endorse systemic corticosteroids(CS) in severe CAP, the role of CS across all severities remains unclear. Evidence outside ICU-level CAP is limited, raising questions about broader applicability. This study aimed to evaluate the impact of CS on oxygen support and other clinical outcomes in patients hospitalized with CAP of any severity.


Methods: This was a retrospective cohort study of patients aged 18–65 years admitted for CAP to a Southeast Advocate Health hospital between December 2023 and April 2024. Patients with viral infections, hospital-acquired pneumonia, CAP diagnosis 7–14 days prior, chronic systemic CS use, pregnancy, or interfacility transfer were excluded. The primary outcome was a composite of increased oxygen support, vasopressor requirement, or in-hospital mortality. Secondary outcomes included individual composite components, acute kidney injury (AKI), major bleeding, insulin requirements, hospital length of stay, and ICU-, vasopressor-, and ventilator-free days. Chi-squared and Welch’s t-tests were used where appropriate.


Results: Of 560 patients screened, 227 met inclusion criteria. Mean age was 51.5 years; 56% were white. Comorbidities included diabetes (38%), asthma (10%), and COPD (19%). Patients receiving CS (n=53) were older (54 vs 51 years, p=0.047), more frequently admitted to ICU (30% vs 14%, p=0.0118), and more likely to have COPD (40% vs 13%, p< 0.001). Despite these differences, the Charlson Comorbidity Index and pneumonia severity index were similar between groups. There was no significant difference in the primary composite outcome (18.9% with CS vs 17.2% without CS, p=0.95). Secondary outcomes were also not significantly different, though non-CS patients had numerically higher rates of AKI (16% vs 11%) and bleeding (24% vs 17%).


Conclusions: Systemic CS were not associated with improved clinical outcomes, including oxygen support or mortality. While more patients in the CS group required ICU admission, outcomes did not differ significantly. Results should be interpreted cautiously due to lack of statistical power and baseline differences. Ongoing analysis with propensity score matching and a larger cohort is planned to validate findings.