Efficacy of higher-dose versus lower-dose corticosteroids in community-acquired pneumonia: a systematic review and network meta-analysis
Authors' conclusion
Compared with placebo or usual care, lower-dose corticosteroids (moderate confidence) and higher-dose corticosteroids (low confidence) were both associated with lower short-term mortality. The indirect higher-versus-lower dose comparison showed no clear mortality difference between dose categories; confidence in this comparison was low.
Study context
- Population
- Hospitalised patients with community-acquired pneumonia
- Participants
- 9,746 patients · 32 randomized controlled trials (RCTs)
- Comparison
- Higher-dose vs lower-dose corticosteroids vs placebo or usual care
- Outcome
- Short-term all-cause mortality
Methodological detailsfrequentist network meta-analysis, Confidence in Network Meta-Analysis (CINeMA) confidence assessment
- Frequentist network meta-analysis
- CINeMA confidence assessment
Pooled result
As reported in the abstract
Short-term mortality
Relative risk (95% CI)
Higher-dose vs Placebo or usual carelow confidence
0.83(0.74–0.92)
Lower-dose vs Placebo or usual caremoderate confidence
0.84(0.75–0.95)
Higher-dose vs Lower-doseindirect comparison; no clear difference; low confidence
0.98(0.83–1.16)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Short-term mortality, severe CAP (subgroup)Higher-dose vs Lower-dose · indirect estimate | 1.01 (0.77–1.33) | |
| 0.512Relative risk (log scale) |
Secondary outcomes, active-dose comparisons
- Mostly imprecise; no consistent advantage of either strategy
Original publication
Efficacy of higher-dose versus lower-dose corticosteroids in community-acquired pneumonia: a systematic review and network meta-analysis. Crit Care. Published 5 July 2026. doi:10.
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