Association between steroid therapy and increased mortality in patients at risk for ARDS

Characteristic	Total cohort (n = 160)	Steroids (n = 91)	Non steroids (n = 69)	P-value
Age	62.50 (43.25, 71.75)	65 (49, 72)	58 (39, 69)	0.073
Female sex, %	74 (46.5)	40 (44)	34 (50)	0.450
SAPS II score	51.66 (16) (95% CI 49.17–54.16)	54.43 (16.25) (95% CI 51.04–57.81)	48.01 (14.96) (95% CI 44.42–51.61)	0.011
GCS	15 (9, 15)	15 (9, 15)	15 (10.5, 15)	0.925
PaO₂/FiO₂	211 (136.16, 313.65)	220 (148, 316.66)	199 (101.5, 311.25)	0.18
Mechanical ventilation, n (%)	54 (33.8)	32 (35.2)	22 (31.9)	0.664
Primary ARDS risk factor
Aspiration, n (%)	28 (17.5)	19 (20.9)	9 (13)	0.089
Pneumonia, n (%)	55 (34.4)	26 (28.6)	29 (42)
Sepsis, n (%)	45 (28.1)	29 (31.9)	16 (23.2)
Shock, n (%)	18 (11.3)	7 (7.7)	11 (15.9)
Other, n (%)	14 (8.8)	10 (11)	4 (5.8)
Patient outcomes
Mortality, n (%)	62 (38.8) (95% CI 31.0–46.0)	39 (42.9) (95% CI 32.0–53.0)	23 (33.3) (95% CI 22.0–45.0)	0.221
Ventilator days	1.15 (0, 3.4)	1.08 (0, 3.36)	1.16 (0, 3.62)	0.528
ICU-LOS days	4.77 (2.05, 9.74)	4.40 (2.18, 11.06)	4.97 (1.90, 9.40)	0.737
Hospital LOS days	8.95 (3.80, 18)	8.08 (3.68, 16.87)	9.90 (3.82, 22.7)	0.521

[i] Abbreviations: SAPS II: Simplified Acute Physiology Score II; GCS: Glasgow Coma Scale; PaO₂: Partial pressure of oxygen; FiO₂: fraction of inspired oxygen; LOS: Length of stay. Data are presented as mean ± standard deviation for normally distributed continuous variables, median (interquartile range) for non-normally distributed continuous variables, and number (percentage) for categorical variables. 95% confidence intervals are provided for key clinical outcomes and severity measures.

Table 2.

Steroid types

Steroid type	Number (n)	Percentage (%)
Dexamethasone	26	28.6
Hydrocortisone	50	54.9
Methylprednisolone	8	8.8
Prednisolone	1	1.1
Prednisone	6	6.6
Total	91	100%

Table 3.

Logistic regression analyses for steroid use and mortality (all patients)

Variable	P value	Odd ratio	95% CI Lower	95% CI Upper
Univariate analysis
Steroid use	0.222	1.500	0.783	2.874
Multivariate analysis
Steroid use	0.446	1.320	0.646	2.697
Age	0.499	0.993	0.974	1.013
SAPS II	0.207	1.015	0.992	1.040
Mechanical ventilation	0.412	0.713	0.317	1.601
PaO₂/FiO₂	0.836	1.000	0.998	1.003
Sepsis	0.168	0.572	0.259	1.265
Shock	0.864	1.100	0.370	3.267
Vasopressor use	0.007	3.424	1.396	8.398

[i] Abbreviations: SAPS II: Simplified Acute Physiology Score II; PaO₂: Partial pressure of oxygen; FiO₂: fraction of inspired oxygen.

Table 4.

Characteristics and clinical outcomes of patients at risk for ARDS (patients received steroids)

Characteristic	Total cohort (n = 76)	Dexamethasone (n = 26)	Hydrocortisone (n = 50)	P-value
Age	64 (49, 72)	63.5 (36.75, 72)	64.5 (52.5, 72)	0.480
Female sex, n (%)	33 (43.4)	7 (26.9)	26 (52)	0.036
SAPS II score	55.83 (15.33) (95% CI 52.33–59.33)	49.27 (16.87) (95% CI 42.46–56.08)	59.24 (13.42) (95% CI 55.43–63.05)	0.006
GCS	15 (9, 15)	15 (8.75, 15)	15 (9, 15)	0.658
PaO₂/FiO₂	211.25 (138.25, 324.75)	208.75 (150.75, 414.25)	212.50 (137.66, 315.42)	0.361
Mechanical ventilation n (%)	26 (34.2)	10 (38.5)	16 (32)	0.573
Primary ARDS risk factor
Aspiration, n (%)	14 (18.4)	2 (7.7)	12 (24)	0.291
Pneumonia, n (%)	22 (28.9)	11 (42.3)	11 (22)
Sepsis, n (%)	25 (32.9)	8 (30.8)	17 (34)
Shock, n (%)	6 (7.9)	2 (7.7)	4 (8)
Other, n (%)	9 (11.8)	3 (11.50)	6 (12)
Patient outcomes
Mortality, n (%)	36 (47.4) (95% CI 36.0–59.0)	7 (26.9) (95% CI 9.0–45.0)	29 (58) (95% CI 44.0–72.0)	0.010
Ventilator days	1.3 (0, 3.4)	1.58 (0, 5.35)	1.26 (0, 3.23)	0.650
ICU-LOS days	3.72 (2.11, 9.78)	3.95 (1.98, 7.38)	3.72 (2.23, 12.21)	0.525
Hospital LOS days	7.8(3.25, 16.84)	7.43 (2.21, 16.36)	8.01 (3.80, 17.08)	0.443

Table 5.

Logistic regression analyses for hydrocortisone and mortality (patients received steroids)

Variable	P value	Odd ratio	95% CI Lower	95% CI Upper
Univariate analysis
Hydrocortisone	0.012	3.748	1.335	10.527
Multivariate analysis
Hydrocortisone	0.035	4.406	1.111	17.476
Age	0.307	0.983	0.952	1.015
SAPS II	0.282	1.022	0.983	1.062
Mechanical ventilation	0.617	1.369	0.400	4.690
PaO₂/FiO₂	0.395	1.002	0.998	1.006
Sepsis	0.516	0.693	0.229	2.098
Shock	0.243	4.214	0.376	47.246
Vasopressor use	0.895	1.124	0.200	6.314

[i] Abbreviations: SAPS II: Simplified Acute Physiology Score II; PaO₂: Partial pressure of oxygen; FiO₂: fraction of inspired oxygen.

References

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Articles in this issue

DOI: https://doi.org/10.62838/jccm-2026-0026 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 418 - 425

Submitted on: Aug 5, 2025

Accepted on: Mar 20, 2026

Published on: Jul 27, 2026

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

ARDS,

Related subjects:

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2026 Sultan Almuntashiri, Andrew Bennett, Duo Zhang, Andrea Sikora, Aaron Chase, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 12 (2026): Issue 3 (July 2026)