What question did this study set out to answer?

This study aims to investigate the effects of adjunctive corticosteroid therapy on clinical outcomes in children with severe viral community-acquired pneumonia.

February 5, 2026Open Access

Association between adjunctive corticosteroid therapy and clinical outcomes in children with severe viral community-acquired pneumonia: A retrospective cohort study

Key Points

This study aims to investigate the effects of adjunctive corticosteroid therapy on clinical outcomes in children with severe viral community-acquired pneumonia.
Conducted a retrospective cohort analysis at a pediatric intensive care unit from January 2016 to December 2019.
Included children with confirmed viral pathogens following established severity criteria.
Compared outcomes between those receiving corticosteroids and those receiving standard therapy.
Corticosteroid treatment was linked to higher secondary infection rates (89.9% vs. 75.0%).
Higher in-hospital mortality was observed in the corticosteroid group (24.7% vs. 6.3%).
Cox regression analysis indicated an increased 60-day mortality hazard associated with corticosteroid exposure.

Abstract

The therapeutic role of corticosteroids (CS) in severe community-acquired pneumonia (CAP) remains contentious, particularly in pediatric populations with viral etiology. Limited pediatric-specific evidence exists regarding CS efficacy in viral CAP, despite widespread clinical utilization. This retrospective cohort analysis examined the association between adjunctive CS therapy and clinical outcomes in children with severe viral CAP. A retrospective cohort analysis was conducted at a tertiary pediatric intensive care unit from January 2016 to December 2019. Inclusion criteria comprised positive viral pathogen detection following the 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America severity criteria. The primary outcome was in-hospital mortality. Secondary outcomes included length of pediatric intensive care unit stay and total hospital stay, duration of conventional mechanical ventilation and extracorporeal membrane oxygenation, and secondary infection rates. Patients were stratified by CS exposure (CS group) versus standard therapy (non-CS group). Among 129 eligible children, 97 (75.2%) received CSs and 32 (24.8%) received standard therapy. Baseline characteristics demonstrated no significant differences ( P > .05). The CS group exhibited significantly higher secondary infection rates (89.9% vs 75.0%, P = .038) and mortality (24.7% vs 6.3%, P = .023). Adenovirus predominated in both cohorts (CS: 50.5%, non-CS: 62.5%), followed by influenza A virus (CS: 37.1%, non-CS: 31.3%). Bronchiolitis obliterans represented the most frequent sequela (CS: 17.5%, non-CS: 12.5%, P = .504). Cox regression survival analysis demonstrated a significantly elevated 60-day mortality hazard (hazard ratio = 4.71 95% confidence interval 1.11–20.0, P = .021). After adjustment for Sequential Organ Failure Assessment scores and procalcitonin, CS exposure maintained independent association with mortality (hazard ratio = 6.32 95% confidence interval 1.37–29.1, P = .018). Adjunctive CS therapy was associated with increased secondary infection rates and 60-day mortality in pediatric severe viral CAP. These findings suggest potential harm from routine CS use in this population, warranting cautious therapeutic consideration (ChiCTR2000038786).

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