Pneumonia最新文献

{"title":"A multicentre case-control study about effectiveness of pneumococcal vaccination against pneumonia hospitalization in at-risk adults.","authors":"María Liébana, Diana Toledo, Núria Soldevila, María Morales-Suarez-Varela, Concepción Prados-Sánchez, Amelia Fernandez-Sierra, Gemma Navarro, Vicente Martín, Judith Chamorro, Mikel Egurrola, Marta Rodriguez-Suárez, Angela Domínguez","doi":"10.1186/s41479-026-00201-6","DOIUrl":"10.1186/s41479-026-00201-6","url":null,"abstract":"<p><p>BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of morbidity in adults with chronic conditions. Although pneumococcal vaccine effectiveness (VE) has been demonstrated in older adults, evidence is scant regarding adults < 65 years. We evaluated pneumococcal VE against CAP-related hospitalization in at-risk adults aged 18–64 years. METHODS: We conducted a multicentre case-control study in Spain (2020–2024). Cases were adults aged 18–64 years with risk conditions, hospitalized for ≥ 24 h, with radiological and clinical patterns compatible with CAP. Controls were hospitalized patients with risk conditions but without pneumonia. Vaccination status was classified as 23-valent pneumococcal polysaccharide vaccine only, pneumococcal conjugate vaccine only, sequential vaccination, or unvaccinated. Logistic regression was used to estimate crude and adjusted odds ratio (OR) values, with VE calculated as (1–OR) × 100. Analyses were stratified by immune status, and a sensitivity analysis was performed excluding SARS-CoV-2 cases. RESULTS: We included 805 cases and 806 controls. None of the pneumococcal vaccination strategies showed significant effectiveness against hospitalization for CAP. In immunocompromised individuals, 23-valent pneumococcal polysaccharide vaccine showed significantly negative adjusted VE (-142.0, 95%CI: -504.4 to -1.1). Excluding SARS-CoV-2 cases yielded similar estimates. CONCLUSIONS: Pneumococcal vaccination was not associated with a reduced hospitalization risk for CAP in adults aged 18–64 years with risk conditions. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ARDS and corticosteroids: beyond COVID-19.","authors":"Mariano Esperatti, Matías Olmos, Nora Fuentes","doi":"10.1186/s41479-026-00200-7","DOIUrl":"10.1186/s41479-026-00200-7","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) remains a high‑mortality condition despite major advances in ventilatory and supportive care. Because lung injury is driven by uncontrolled inflammation and disruption of the alveolar–capillary barrier, corticosteroids have long been considered a biologically plausible therapy. Over several decades, randomized trials have evaluated different corticosteroid types, doses, durations, and initiation timings in heterogeneous populations, including patients with primary ARDS and those with sepsis or pneumonia complicated by ARDS. The COVID‑19 pandemic provided a unique opportunity to study a more homogeneous cause of ARDS, generating additional evidence supporting corticosteroid efficacy in virus‑related respiratory failure. Despite these advances, clinical practice remains variable worldwide. Evolving definitions, diverse trial designs, and etiologic variability have led to uncertainty regarding indication, optimal dosing, drug selection, and treatment duration. The new global definition of ARDS now includes patients supported with noninvasive ventilation or high‑flow nasal oxygen, raising questions about how evidence derived from invasively ventilated populations applies to these groups. Parallel research identifying inflammatory subphenotypes with potentially divergent treatment responses further underscores the need for individualized, evidence‑based strategies. In this review, we examine conceptual, biological, and clinical considerations and synthesize the available evidence to inform decision‑making. We propose a pragmatic, context‑based framework to guide corticosteroid use in ARDS according to etiology and patient characteristics, emphasizing early initiation—ideally within 24–48 hours—and regimens equivalent to ≥80 mg/day of methylprednisolone or ≥400 mg/day of hydrocortisone for at least seven days, which have demonstrated efficacy with an acceptable safety profile. Research priorities include optimizing dose and duration, evaluating non‑ventilated and underrepresented subgroups, and clarifying phenotype‑specific effects and long‑term safety.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumonia as a predictor of diabetes mellitus and coronary heart disease: a national cohort study.","authors":"Filip Jansåker, Xinjun Li, Kristina Sundquist, Henning Stenberg","doi":"10.1186/s41479-026-00199-x","DOIUrl":"10.1186/s41479-026-00199-x","url":null,"abstract":"<p><p>BACKGROUND: Pneumonia is a common infection that leads to frequent hospitalizations and primary healthcare visits. Previous smaller studies have indicated high prevalence of undiagnosed diabetes mellitus (DM) and increased subsequent risk of coronary heart disease (CHD) among patients with pneumonia. However, previous studies have not used nationwide data that include diagnoses from primary healthcare settings, where most pneumonias are treated. The aim of this study was to examine whether pneumonia is associated with subsequent DM and CHD. METHODS: This was an open nationwide cohort study of adults 35–75 years of age in Sweden 2007–2018, including national registers and population-based primary healthcare data. The outcomes were DM and CHD, and individuals with outcomes diagnosed before the index date (including 2002–2005) were excluded. The index date was set as the first pneumonia diagnosis or the first healthcare contact (in those without pneumonia) during the study period. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) while adjusting for potential confounders. RESULTS: A total of 4,580,606 individuals without previously diagnosed DM and 4,661,052 individuals without previously diagnosed CHD were included; of these, 348,024 individuals were diagnosed with DM and 295,592 with CHD during follow-up, respectively. Pneumonia preceded DM in 104,598 (30.1%) and CHD in 94,087 (31.8%) individuals. Compared with no diagnosis, pneumonia was associated with an age-adjusted HR of 1.12 (95% CI 1.11–1.13) for DM and 1.18 (95% CI 1.17–1.19) for CHD. In the full model, pneumonia was associated with a HR of 1.11 (95% CI 1.10–1.12) for both outcomes. Several complementary analyses were conducted, showing significant associations across most age-groups, in both sexes, across different follow-up periods (e.g. <1 year and ≥ 10 years), and in patients diagnosed with pneumonia in primary healthcare settings. CONCLUSIONS: This nationwide study found that pneumonia is associated with subsequent DM and CHD. The findings indicate that pneumonia has a potential role as a clinical predictor of DM or CHD, including in primary healthcare settings, which warrants further clinical studies. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The heterogeneous treatment effect of adjuvant therapy with corticosteroids in patients with Community-Acquired Pneumonia: a review.","authors":"Jim M Smit, A Torres, P A van der Zee, Jesse H Krijthe, Ignacio Martin-Loeches","doi":"10.1186/s41479-026-00198-y","DOIUrl":"10.1186/s41479-026-00198-y","url":null,"abstract":"<p><p>Randomized Controlled Trials (RCTs) assessing adjuvant corticosteroids for hospitalized Community-Acquired Pneumonia (CAP) show mixed results, suggesting Heterogeneity of Treatment Effect (HTE). Current guidelines conflict: some restrict use to septic shock, while others advocate for broader application in severe CAP. Among three recent, large RCTs focused on severe CAP, however, only one demonstrated significant benefit, raising the question: should severity-based treatment guidance really be preferred?. The debate surrounding corticosteroid use in CAP is complicated by two issues: the lack of a unified definition for ‘severe CAP’, with definitions either based on the American Thoracic Society criteria or severity scores like the Pneumonia Severity Index, and the reliance on Aggregate Data Meta-Analyses (ADMAs). ADMAs synthesize trial results by categorizing entire RCTs as severe or non-severe, while most RCT populations included patients with varying disease severities. Individual Patient Data Meta-Analyses (IPDMAs) enable stratification on a patient-level. Our recent IPDMA utilized multivariate predictive HTE modelling in six RCT datasets to identify patient characteristics predicting corticosteroid benefit, which suggested C-reactive protein (CRP) as a predictor of benefit. Therefore, this finding was externally validated in two other RCTs, revealing statistically significant HTE found across baseline CRP subgroups (i.e., ≤ 204 mg/L vs. >204 mg/L), while no such HTE was found across severity-based subgroups. These findings may advocate for corticosteroid treatment guided by CRP instead of disease severity. CRP, however, is unlikely the sole driver of corticosteroids benefit, as other potential sources of HTE like imaging or cytokines (‘known unknowns’) or other unmeasured variables (‘ unknown unknowns’) may exist, and moreover, our IPDMA post-hoc suggested HTE across aetiology and treatment timing. Moving forward, the efficacy of precision medicine in CAP hinges on rigorous replication of HTE findings —being notoriously susceptible to false positives— in independent datasets, and harmonized and standardized data collection in future trials. Based on current evidence, CRP may serve as a pragmatic tool to guide corticosteroid treatment, but given to the drug’s “pendulum swings” from broad use to avoidance over the last decades, caution remains essential.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health disparities in the burden of pneumococcal disease in US adults.","authors":"Nicole Cossrow, Salini Mohanty, Kelly D Johnson, Thomas Weiss, Sheba Nellore, Lindsay McNamee, Laura De Benedetti, Elmira Flem, Kristen Feemster","doi":"10.1186/s41479-026-00197-z","DOIUrl":"10.1186/s41479-026-00197-z","url":null,"abstract":"<p><p>BACKGROUND: There are significant racial and environmental disparities in the burden of pneumococcal disease. Understanding the role of social determinants of health (SDoH) on pneumococcal disease can help health authorities identify health inequities and develop interventions to reduce these disparities. This targeted literature review (TLR) aimed to examine the clinical and economic burden of pneumococcal disease in US adults with a focus on SDoH such as race, urbanicity, and socioeconomic status. METHODS: A TLR of studies published between January 2012 and July 2024 was conducted using PubMed (via Medline) and Centers for Disease Control and Prevention (CDC) surveillance data. Supplementary searches were made on Google Scholar to address data gaps. Outcomes of interest were incidence, prevalence, mortality, healthcare resource use, costs, and vaccine coverage rates by race/ethnicity, urbanicity (population density), and socioeconomic variables (income, education, employment status and home ownership). RESULTS: Of 4,609 identified publications, 12 studies were included. Black adults had the highest incidence and mortality rates and longest hospital stay due to pneumococcal disease across all adult age groups. Additionally, Black (compared to non-Black) adults were more likely to be hospitalized at younger ages (50–64 years). Black adults ≥50 years incurred significantly higher pneumococcal disease hospitalization costs compared to non-Black adults. Lower urbanicity displayed higher mortality rates for adults with pneumonia. Adult patients 18–64 years living in more disadvantaged areas had a higher risk of hospitalization for IPD. Similarly, adults living in higher levels of area-based poverty had increased rates of CAP hospitalizations. Incidence of community-acquired pneumonia (CAP) was higher in early retirees and their adult dependents compared to their employed counterparts and adult dependents. Vaccination rates were lower in Black adults, rural residents, those with lower SES, education or income, blue-collar workers, and those who did not own a home. CONCLUSION: Disparities in pneumococcal disease burden and vaccination uptake exist among US adults, particularly among Black adults, rural residents and those with lower education and income. There is paucity of studies examining disparities in pneumococcal disease and inequities according to race, urbanicity, and socioeconomic status warranting further investigation of the topic to inform prevention strategies. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis of clinical pneumonia in undernourished children in rural Gambia.","authors":"Yasir Shitu Isa, Megan Carelus, Isabelle Silber, Rasheed Salaudeen, Golam Sarwar, Yekini Ajao Olatunji, Ilias Hossain, Isaac Osei, Galega Lobga, Banjo Adeshola, Ousman Barjo, Momodou M Drammeh, Umberto D'Alessandro, Patricia L Hibberd, Grant A Mackenzie, Clarissa Valim","doi":"10.1186/s41479-025-00194-8","DOIUrl":"10.1186/s41479-025-00194-8","url":null,"abstract":"<p><p>BACKGROUND: Undernutrition significantly increases the risk of severe infections and mortality in children under five, particularly in low- and middle-income countries. Pneumonia, a leading cause of childhood death, is especially dangerous in undernourished children, yet prognostic measures to identify those at highest risk are lacking. OBJECTIVE: To identify algorithms of poor prognosis in undernourished children with clinical pneumonia for early identification of children at risk for poor outcomes. METHODS: This study analyzed a subset of children enrolled in a cohort designed to identify biomarkers of bacterial pneumonia. Children aged 2–59 months with clinical pneumonia were recruited from two rural Gambian hospitals. Clinical and anthropometric data were collected at baseline, during hospitalization, and at 30-day follow-up. Nutritional status was classified using WHO definitions for stunting (height-for-age Z-scores) and wasting (weight-for-height Z-scores) as severe (Z-scores ≤ -3), moderate (-2 ≥ Z-scores > -3), and mild (-1 ≥ Z-scores > -2). Prognostic outcomes were classified into good and poor. Poor prognosis included death, prolonged hospital stay (≥ 7 days), post-discharge care-seeking, and difficult to feed during admission. Good prognosis was based on a hospital stay < 3 days, with good outcomes within 30 days of the initial visit. Classification tree models and penalized logistic regression models (fit through elastic net) were used to identify combinations of predictors of poor prognosis (prognostic signatures). RESULTS: A total of 246 children with clinical pneumonia and undernutrition (wasting or stunting) were included. Children with poor prognosis presented more frequently with respiratory distress, hypoxemia, reduced capacity oforal feeding difficulty, and anemia. As expected, undernutrition was associated with adverse outcomes. The final prognostic algorithms were accurate to identify undernourished children at risk of poor prognosis: with sensitivity and specificity > 80% and area under the receiver operating characteristic curve ≥ 0.80. Furthermore, we identified accurate prognostic signatures among children with both wasting and stunting. CONCLUSION: Measures collected at admission in undernourished children with clinical pneumonia can identify those at risk of poor outcomes. The prognostic signatures developed in this study may inform early risk stratification and guide timely intervention, particularly in resource-limited settings. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13014833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinopenia and prognosis in severe community-acquired pneumonia.","authors":"Catia Cilloniz, Tatiana Castañeda, Antonio Campanella, Riccardo Guglielmi, Albert Gabarrús, Sara Granero, Cristina Calvo-García, Maria Angeles Marcos, Antoni Torres","doi":"10.1186/s41479-026-00196-0","DOIUrl":"10.1186/s41479-026-00196-0","url":null,"abstract":"<p><p>BACKGROUND: Eosinopenia has been reported as a marker of severity in infections, but its prognostic value in patients with severe community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU) is unclear. METHODS: We retrospectively analyzed 496 patients with severe CAP admitted to the ICU and stratified them according to the presence of eosinopenia on admission. We compared clinical characteristics, laboratory data, microbiological etiology, treatment, complications, and outcomes between groups. Independent factors associated with 30-day mortality were identified using multivariable Cox regression. Discriminative performance of eosinophil count, severity scores (CRB-65, CURB-65, PSI), and a modified CURB-65 incorporating eosinopenia (CURB-65Eos) were assessed using ROC curves. RESULTS: Eosinopenia was present in 163/496 patients (33%). Age and most comorbidities were similar between groups. Compared with non-eosinopenic patients, eosinopenic patients had lower leukocyte, neutrophil, and lymphocyte counts and more frequent viral or polymicrobial infections. They more often required invasive mechanical ventilation (58% vs. 45%, p = 0.009) and developed pleural effusion (30% vs. 19%, p = 0.008). In-hospital and 30-day mortality were higher in the eosinopenia group (21% vs. 13%, p = 0.036; 20% vs. 12%, p = 0.022). In the predefined multivariable Cox model, eosinopenia was independently associated with increased 30-day mortality (HR 1.95; 95% CI 1.19 to 3.20; p = 0.008). Eosinophil counts alone showed poor discrimination for 30-day mortality (AUC 0.562), while established severity scores performed moderately. CURB-65Eos showed a numerical but nonsignificant improvement over CURB-65. CONCLUSIONS: Eosinopenia is common in patients with severe CAP admitted to the ICU and is independently associated with increased 30-day mortality. It may serve as a simple and inexpensive biomarker for the early identification of high-risk patients and could complement established severity scores to support closer monitoring and earlier escalation of care. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13014991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarker-guided use of corticosteroids in pneumonia.","authors":"Abel Soriano Puig, Veronica Monforte, Marta Camprubí-Rimblas, Antonio Artigas, Adrián Ceccato","doi":"10.1186/s41479-025-00193-9","DOIUrl":"10.1186/s41479-025-00193-9","url":null,"abstract":"<p><p>Community-acquired pneumonia (CAP) is one of the leading causes of death worldwide. Although corticosteroids have been proposed as immunomodulatory, controversies surrounding the results of clinical trials have limited their widespread use. This review aims to determine which biomarker-guided corticosteroid treatment for CAP is generally agreed upon in the latest published studies and to discuss the main aspects to be taken into consideration based on lessons learnt from patients with conditions such as influenza, SARS-CoV-2 infection or the recently identified subphenotypes in acute respiratory distress syndrome (ARDS). Most studies have demonstrated that high C-reactive protein concentrations at the time of admission are associated with a hyperinflammatory state and that patients are more likely to benefit from corticosteroid treatment if they have high concentrations. High levels of C-reactive protein (CRP) were used as an inclusion criterion in one clinical trial, demonstrating that treatment failure was reduced in the corticosteroid group. A post-hoc analysis of the results of several studies also showed that CRP levels above 200 mg/L were associated with benefits in patients receiving corticosteroids. Recent guidelines have proposed the use of corticosteroids in patients with severe CAP or septic shock. Corticosteroids could be more beneficial for patients with a hyperinflammatory subphenotype; however, there are currently no prospective studies evaluating this approach. Further studies are needed to clarify the role of biomarkers in personalised medicine for patients with CAP. In the meantime, patients with severe CAP or high CRP levels should be treated with corticosteroids.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of corticosteroids in severe viral pneumonia: lessons from COVID-19 and influenza.","authors":"Monica Gordon, Paula Ramirez","doi":"10.1186/s41479-025-00192-w","DOIUrl":"10.1186/s41479-025-00192-w","url":null,"abstract":"<p><p>BACKGROUND: Corticosteroids have long been used as immunomodulatory agents in viral respiratory infections, but their role in influenza and COVID-19 remains controversial. While both diseases share overlapping pathogenic mechanisms involving hyperinflammation and immune dysregulation, clinical evidence suggests divergent outcomes in response to corticosteroid therapy. OBJECTIVE: This review critically examines the evidence regarding corticosteroid use in influenza and COVID-19, focusing on their impact on mortality, disease progression, and secondary infections. METHODS: A narrative review was conducted including randomized controlled trials, meta-analyses, and major observational studies published between 2000 and 2025. Data were analyzed comparatively for influenza (seasonal and pandemic strains) and SARS-CoV-2 infection. RESULTS: In influenza, most studies associate corticosteroid administration—particularly at high doses or prolonged courses—with increased mortality, delayed viral clearance, and higher rates of secondary bacterial pneumonia. Conversely, in COVID-19, randomized trials such as RECOVERY demonstrated that low-to-moderate doses of dexamethasone significantly reduce mortality in patients requiring oxygen or mechanical ventilation, without clear benefit in mild disease. These opposing outcomes highlight the importance of timing, dosing, and patient selection, reflecting distinct immunopathological trajectories between the two infections. CONCLUSIONS: Corticosteroid therapy exerts context-dependent effects in viral pneumonia. While detrimental in most cases of influenza, it is beneficial in severe COVID-19 when guided by systemic inflammation. Future strategies should focus on personalized and real-time immune monitoring to tailor immunomodulatory interventions to each patient’s inflammatory and virological status. </p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12961784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroids in severe community-acquired pneumonia: friend, foe or both?","authors":"Federico Carpenteri, Catia Cilloniz, Antoni Torres","doi":"10.1186/s41479-025-00195-7","DOIUrl":"10.1186/s41479-025-00195-7","url":null,"abstract":"<p><p>In most patients with CAP, corticosteroids should be avoided due to complications such as immunosuppression and hyperglycaemia. Studies of hydrocortisone have shown corticosteroids might be of benefit in patients with severe CAP and high inflammation measured by CRP. Differences in results between trials of corticosteroid therapy suggest heterogenicity in study populations and the need for future studies in standardized populations. Scientific evidence shows corticosteroid use can reduce short-term mortality and the need for mechanical ventilation in hospitalized patients with severe CAP. However, this approach should not be generalized to all patients with CAP. Use should be guided by biomarkers such as CRP to identify patients who will benefit the most. Corticosteroids should not be routinelly used in viral pneumonia, with the exception of hypoxemic SARS-CoV-2 pneumonia, in which their benefit is well established.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"18 1","pages":"5"},"PeriodicalIF":3.8,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12874727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}