Effectiveness of Corticosteroid Strategy in Three Community‐Acquired Pneumonia Clinical Phenotypes: A Multicenter Retrospective Cohort Study

Comprehensive understanding of community‐acquired pneumonia (CAP) patient's clinical phenotypes is imperative for facilitating prognosis and formulating treatment guidelines. However, the efficacy of corticosteroid therapy in managing CAP remains a topic of debate requiring further scrutiny. A multicenter retrospective cohort study was conducted across four clinical centers to analyze data from CAP patients. Different primary and secondary clinical outcomes were compared among various CAP patients. Intravenous corticosteroid treatment strategies were later analyzed using logistic regression, Cox proportional hazards models, and the marginal structural model (MSM) in overall CAP patients. Finally, several predefined subgroup and sensitivity analyses were also performed. Three distinct clinical phenotypes of CAP patients were identified based on demographic and laboratory indicators. Phenotype C displayed higher mortality rates and organ dysfunction compared to other phenotypes. The impact of intravenous corticosteroid treatment was assessed through logistic regression, Cox proportional hazards models, and MSM, and results showed that patients with phenotype C were more likely to benefit from intravenous corticosteroid treatment, and the optimal dose was 80 mg/d; the duration of treatment should be no more than 5 days. The study findings suggest that corticosteroid therapy was associated with improved outcomes in CAP patients, particularly those within phenotype C, after considering time‐dependent variables and adjusting for confounders using MSM. Subgroup and sensitivity analyses provided insights into the specific dosages and durations of corticosteroid treatment tailored to each phenotype. These results highlight the potential of phenotype‐guided therapy in optimizing CAP treatment strategies for improved patient outcomes.