Adjunctive corticosteroids and mortality in non-HIV patients with Pneumocystis jirovecii pneumonia: A systematic review and meta-analysis
Abstract
BACKGROUND
The role of adjunctive corticosteroids in non-HIV PJP remains controversial.
METHODS
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing adjunctive corticosteroids plus standard antimicrobial therapy versus standard therapy alone in HIV-negative adults with PJP. We searched PubMed, Embase, Web of Science, and Cochrane Library from inception to December 19, 2025. The primary outcome was all-cause mortality. We performed meta-analyses using random-effects models, subgroup analyses by mortality timing, and sensitivity analyses.
RESULTS
Twenty studies (one RCT, 19 observational studies) involving 3816 patients were included. Among 2899 patients receiving corticosteroids, 756 died (26.1%), compared to 246 deaths among 917 controls (26.8%). The pooled analysis showed no significant association between adjunctive corticosteroids and all-cause mortality (odds ratio [OR] 1.10, 95% confidence interval [CI]: 0.86-1.41; P = 0.43; I² = 21%). Subgroup analyses for short-term (≤30-day) mortality (OR: 1.13, 95% CI: 0.78-1.63) and long-term (>30-day) mortality (OR: 1.36, 95% CI: 0.79-2.32) also demonstrated no significant benefit. Results were robust in sensitivity analyses.
CONCLUSION
Adjunctive corticosteroids were not associated with reduced mortality in non-HIV PJP. However, the overall certainty of evidence was very low. Based on current evidence, routine corticosteroid use is not supported, and these…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,816 participants or records.
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