Long-acting glucocorticoids improves survival of critically ill patients with sepsis: Study

A new study published in the Frontiers in Pharmacology revealed that long-acting glucocorticoid therapy to be associated with better survival in severely ill patients with sepsis and acute respiratory failure.

Although long-acting glucocorticoids are often used in the ICU, it is still unclear how exactly they affect ICU mortality in septic patients experiencing severe respiratory failure. Thus, this study is to find out if using long-acting glucocorticoids lowers the death rate in this severely sick group.

Version 3.0 of the MIMIC-IV (Medical Information Mart for Intensive Care) database was used to retrospectively identify adult patients who met the Sepsis-3 criteria and were also having acute respiratory failure. ICU mortality, which is defined as death that occurs before to discharge from the critical care unit, was the main outcome of interest.

Kaplan-Meier survival curves were used in time-to-event studies, and log-rank testing was used to assess statistical significance. The severity of the disease and treatment-related factors were further adjusted for using a multivariable Cox proportional hazards regression model, and additional exploratory subgroup analyses were conducted to evaluate any potential impact alterations.

A total of 10,707 patients with a diagnosis of Septic Patients with Acute Respiratory Failure were examined in this study; 2,298 of them died in the intensive care unit. Based on the recorded administration of long-acting glucocorticoids during intensive care unit therapy, patients were categorized into groups that had been exposed to and those who had not.

Even after controlling for adjustment in multivariable Cox regression analysis, the crude mortality rate was greater in the unexposed group than in the glucocorticoid-exposed cohort. Significant interaction effects were found by subgroup analysis, especially for patients on continuous renal replacement treatment and those with cancer.

Propensity score-matched studies, which showed persistent mortality disparities across the groups, further supported the main findings. The long-acting glucocorticoid group exhibited a substantial survival benefit over the short-acting glucocorticoid group, according to sensitivity analysis of the various treatment groups.

Overall, among critically sick septic patients with acute respiratory failure, the use of long-acting glucocorticoids was associated with a lower ICU death rate. In this high-risk patient population, this data suggests that long-acting glucocorticoid medication may offer a survival benefit.

Reference:

Deng, Y., Wang, S., Zhou, S., Zhao, W., Wang, A., & Gao, J. (2025). Impact of long-acting glucocorticoids on ICU mortality in Septic Patients with Acute Respiratory Failure: A MIMIC-IV based cohort study. Frontiers in Pharmacology, 16, 1663974. https://doi.org/10.3389/fphar.2025.1663974