Recommended Citation
Caringella C, George A, Argotsinger J. Retrospective Evaluation of Steroid Utilization for Pneumonia Treatment in the Critically Ill Population. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Severe community-acquired pneumonia (CAP) is associated with significant morbidity and mortality in critically ill patients. Adjunctive corticosteroid therapy remains controversial. IDSA guidelines recommend routine steroid use in severe CAP, while SCCM guidelines support corticosteroids based on the recent landmark trial, CAPE COD.
Purpose:
This study evaluated the effect of adjunctive steroid therapy versus no steroid therapy on clinical outcomes in patients admitted to the intensive care unit (ICU) with severe CAP and real-world adherence to guideline endorsed steroid regimens. Risk factors associated with clinical failure were also assessed.
Methods:
We conducted a multi-center retrospective evaluation of adults ≥18 years admitted to the ICU with CAP from January 1, 2024, to June 30, 2025. Patients with hospital- or ventilator-acquired pneumonia, viral pneumonia, recent systemic corticosteroid use (≥5 mg prednisone equivalent within 7 days), or steroid initiation for non-CAP indications were excluded. Clinical failure was defined as death attributed to CAP, failure to return to pre-morbid oxygen status or escalation of oxygen requirements within 4 days of ICU admission. Baseline characteristics were compared between groups; regression analysis was used to identify predictors of clinical failure.
Results:
In total, 405 patients were included; 179 (44%) received steroids and 226 (56%) did not. Patients in the steroid cohort had higher rates of acute respiratory distress syndrome (ARDS) on admission, increased oxygen and vasopressor requirements, and longer ICU and hospital length of stay. Among patients meeting CAPE COD severe criteria, clinical success rates were higher in the non-steroid group versus the steroid group, 52.6% vs 61.7% (p=0.05). Within the steroid treatment group, only 62.6% of patients received steroids per guideline approved dosing strategies. Regression analysis identified older age, higher SAPS-2 score, severe pneumonia classification, vasopressor use, and immunosuppression as predictors of clinical failure. Treatment with steroids was not independently associated with success.
Conclusion:
In this real-world retrospective evaluation, adjunctive steroid therapy for severe CAP did not improve rates of clinical success. Variables associated with poorer outcomes were advanced age, higher SAPS- 2 score, severe pneumonia classification, vasopressor use, and immunosuppression.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Retrospective Evaluation of Steroid Utilization for Pneumonia Treatment in the Critically Ill Population
Background/Significance:
Severe community-acquired pneumonia (CAP) is associated with significant morbidity and mortality in critically ill patients. Adjunctive corticosteroid therapy remains controversial. IDSA guidelines recommend routine steroid use in severe CAP, while SCCM guidelines support corticosteroids based on the recent landmark trial, CAPE COD.
Purpose:
This study evaluated the effect of adjunctive steroid therapy versus no steroid therapy on clinical outcomes in patients admitted to the intensive care unit (ICU) with severe CAP and real-world adherence to guideline endorsed steroid regimens. Risk factors associated with clinical failure were also assessed.
Methods:
We conducted a multi-center retrospective evaluation of adults ≥18 years admitted to the ICU with CAP from January 1, 2024, to June 30, 2025. Patients with hospital- or ventilator-acquired pneumonia, viral pneumonia, recent systemic corticosteroid use (≥5 mg prednisone equivalent within 7 days), or steroid initiation for non-CAP indications were excluded. Clinical failure was defined as death attributed to CAP, failure to return to pre-morbid oxygen status or escalation of oxygen requirements within 4 days of ICU admission. Baseline characteristics were compared between groups; regression analysis was used to identify predictors of clinical failure.
Results:
In total, 405 patients were included; 179 (44%) received steroids and 226 (56%) did not. Patients in the steroid cohort had higher rates of acute respiratory distress syndrome (ARDS) on admission, increased oxygen and vasopressor requirements, and longer ICU and hospital length of stay. Among patients meeting CAPE COD severe criteria, clinical success rates were higher in the non-steroid group versus the steroid group, 52.6% vs 61.7% (p=0.05). Within the steroid treatment group, only 62.6% of patients received steroids per guideline approved dosing strategies. Regression analysis identified older age, higher SAPS-2 score, severe pneumonia classification, vasopressor use, and immunosuppression as predictors of clinical failure. Treatment with steroids was not independently associated with success.
Conclusion:
In this real-world retrospective evaluation, adjunctive steroid therapy for severe CAP did not improve rates of clinical success. Variables associated with poorer outcomes were advanced age, higher SAPS- 2 score, severe pneumonia classification, vasopressor use, and immunosuppression.
Affiliations
Advocate Lutheran General Hospital