Corticosteroids use in influenza pneumonia linked to increased mortality, ICU stay

For the study, the investigators searched the databases for the controlled studies that compared the effects of corticosteroids and placebo in adult patients with influenza pneumonia. The final analysis involved ten trials consisting of 6548 patients.

The primary outcome was mortality, and the secondary outcomes were mechanical ventilation days, length of stay in the intensive care unit, and the rate of secondary infection.

• Mortality was higher in patients who received corticosteroids. Similar results were also observed in the subgroup analysis of patients with H1N1 and patients with other viral types.


• Corticosteroids had no effect on MV days.


• ICU LOS was longer in the corticosteroid group.


• The rate of secondary infection was higher in patients who received corticosteroids than in the control group.

There are several potential mechanisms that could underlie the higher mortality and ICU LOS observed in patients with influenza pneumonia who received corticosteroids.

1. Corticosteroids reduce systemic inflammation.


2. The patients who received corticosteroids were more likely to develop secondary bacterial pneumonia due to immunosuppression.


3. Due to the immune-suppressing effects of corticosteroids, the risk of developing critical illness is increased in corticosteroid-treated patients.


4. Other corticosteroid-related adverse outcomes, such as cardiovascular events, including fluid retention, premature atherosclerotic disease, and arrhythmias, also increased mortality in patients with influenza pneumonia.

"Corticosteroids could increase mortality in patients with influenza pneumonia. Randomized controlled studies are needed to further verify this conclusion," concluded the authors.