Corticosteroid treatment in influenza is associated with increased mortality and hospital-acquired infection, but the evidence relates mainly to high corticosteroid doses and is of low quality with potential confounding by indication a major concern.

We identified 30 eligible studies, all observational apart from one randomized controlled trial.

21 observational studies were included in the meta-analysis of mortality, which suggested an adverse association with corticosteroid therapy.

Two researchers independently assessed studies for inclusion.

Risk of bias was assessed using the Cochrane Risk of Bias tool (randomized controlled trials) or Newcastle-Ottawa Scale (observational studies).

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