What question did this study set out to answer?

This study aims to evaluate the impact of corticosteroid therapy on short- and intermediate-term outcomes in patients with influenza-related ARDS.

March 26, 2026

1608: Corticosteroids in Influenza-Related Ards: Real-World 6-Month Outcomes From a Global Federated Study

Puntos clave

This study aims to evaluate the impact of corticosteroid therapy on short- and intermediate-term outcomes in patients with influenza-related ARDS.
Retrospective cohort study using TriNetX Global Collaborative Network
Analyzed electronic health records from 146 healthcare organizations
Identified adult patients with ARDS and influenza; divided into corticosteroid-treated and untreated groups
Used propensity score matching to balance baseline characteristics
Assessed outcomes at 1, 3, and 6 months, focusing on in-hospital mortality and secondary complications.
Corticosteroid use linked to higher odds of in-hospital mortality at 1 month (OR 1.71), 3 months (OR 1.70), and 6 months (OR 1.69)
Increased risks of respiratory failure (ORs 1.37–1.57) and mechanical ventilation (ORs 2.03–2.10)
Higher rates of heart failure exacerbation (ORs 2.49–2.58) and dialysis (ORs 1.81–2.18) were observed
Significantly elevated hazard ratios for heart failure (HR 2.13) and dialysis (HR 1.778) at 6 months
No significant differences noted for myocardial infarction, stroke, or acute kidney injury.

Resumen

Introduction: The role of systemic corticosteroids in influenza-associated acute respiratory distress syndrome (ARDS) remains debated, with limited real-world data available. This study evaluated short- and intermediate-term outcomes following corticosteroid therapy in patients with influenza-related ARDS. Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network, encompassing electronic health records from 146 healthcare organizations. Adult patients with concurrent diagnoses of ARDS and influenza were identified and divided into two groups: those treated with systemic corticosteroids (n = 7,146) and those not treated (n = 19,300). Propensity score matching was used to balance baseline characteristics. Outcomes were assessed at 1, 3, and 6 months. The primary outcome was in-hospital mortality. Secondary outcomes included myocardial infarction (MI), stroke, respiratory failure, mechanical ventilation, heart failure exacerbation, acute kidney injury (AKI), dialysis, and readmission. Odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated. Results: Corticosteroid use was associated with significantly higher odds of in-hospital mortality at 1 month (OR 1.71, 95% CI 1.55–1.88), 3 months (OR 1.70, 95% CI 1.56–1.86), and 6 months (OR 1.69, 95% CI 1.55–1.85; all p < 0.001). Increased risks were also observed across all timepoints for respiratory failure (ORs 1.37–1.57), mechanical ventilation (ORs 2.03–2.10), heart failure exacerbation (ORs 2.49–2.58), dialysis (ORs 1.81–2.18), and hospital readmission (ORs 4.27–5.64). At 6 months, hazard ratios confirmed elevated risks for heart failure exacerbation (HR 2.13, p < 0.001) and dialysis (HR 1.778, p < 0.001). No significant differences were found for MI, stroke, or AKI. Conclusions: In this large multicenter analysis, systemic corticosteroid use in influenza-related ARDS was associated with increased mortality and higher rates of several complications up to 6 months. These findings suggest potential harm and underscore the need for caution when prescribing corticosteroids in this setting. Further randomized trials are needed to better define their role.

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