Outcomes of corticosteroid treatment in critical Ill adult patients with respiratory viruses-related community acquired pneumonia - a propensity-matched case control study.

Abstract

To assess the outcomes of corticosteroid treatment in critically ill patients with respiratory virus-related community-acquired pneumonia (CAP). Adult patients who were admitted to the intensive care unit and had a polymerase chain reaction-confirmed diagnosis of respiratory virus-related CAP were included. Patients with and without corticosteroid treatment during the hospital course were retrospectively compared using a propensity score-matched case-control analysis. From January 2018 to December 2020, 194 adult patients were enrolled with 1:1 matching. The 14-day and 28-day mortality rates did not differ significantly between patients treated with and without corticosteroids (14-day mortality: 7% versus 14%, P=0.11; 28-day mortality: 15% versus 20%, P=0.35). However, multivariate analysis by using a Cox regression model revealed that corticosteroid treatment was an independent factor predicting decreased mortality (adjusted odds ratio, 0.46; 95% confidence interval, 0.22-0.97, P=0.04). Subgroup analysis revealed lower 14-day and 28-day mortality rates in patients younger than 70 years treated with corticosteroids than in those not treated with corticosteroids (14-day mortality: 6% versus 23%; P=0.01 and 28-day mortality: 12% versus 27%; P=0.04). Non-elderly patients with severe respiratory virus-related CAP are more likely to benefit from corticosteroid treatment than elderly patients.