Inflammation and Adrenal Dysfunction in Community-Acquired Pneumonia: Should Corticosteroids be used?

Abstract

Community-acquired pneumonia is a leading cause of hospitalization and death in adults, particularly when it progresses to severe forms. Beyond the use of antibiotics, a deregulated inflammatory response plays a critical role in the progression of pulmonary and systemic damage. In this context, corticosteroids have emerged as a promising though still controversial adjunctive intervention, so their recommendation is not yet generalized. Recent studies, including meta-analyses and randomized clinical trials, show that their use can decrease mortality, shorten hospital stay, and reduce the need for mechanical ventilation. These benefits appear more evident in patients with severe systemic inflammation or relative adrenal dysfunction. However, adverse effects such as hyperglycemia or the risk of secondary infections require careful patient selection. Discrepancies persist among clinical guidelines, and the methodological heterogeneity of the studies limits their universal applicability. Current evidence supports not only the rational use of antibiotics but also of glucocorticoids in severe community-acquired pneumonia, recommending that their use should be individualized to the clinical profiles and inflammatory biomarkers of each patient. Moreover, further research is needed to define optimal dosage and duration schemes, and to identify subgroups that truly benefit from the treatment. This manuscript seeks to integrate pathophysiology, clinical evidence, and current controversies, offering a critical perspective on the use of corticosteroids in severe community-acquired pneumonia.