Corticosteroid use and mortality of severe community-acquired pneumonia in children: A propensity score-matched analysis

Background The role of corticosteroids in the management of severe community-acquired pneumonia (CAP) in children remains controversial, with limited pediatric evidence. Recent studies have suggested that the effect of corticosteroids varies among subgroups, particularly according to cardiovascular status. The present study thus evaluated the effect of corticosteroids on in-hospital mortality in children with severe CAP and described subgroup differences by concomitant organ failure, age, and the microbial diagnosis. Methods This retrospective cohort study used a national inpatient database in Japan to identify children under 20 years old admitted with pneumonia between July 2010 and March 2022 who received ventilatory support within the first 2 days of admission. We performed one-to-one nearest-neighbor propensity score matching to compare children who received corticosteroids within 2 days of admission and continued for ≥3 days (steroid group) with those who did not (non-steroid group). The primary outcome was in-hospital mortality, assessed in matched pairs with subgroup analyses. Results Of the 11,427 children with severe CAP, propensity score matching yielded 3,081 matched pairs. In-hospital mortality was 1.6% in the steroid group and 1.7% in the non-steroid group (odds ratio, 0.94; 95% confidence interval CI: 0.68–1.31; p = 0.72). Among 359 children with cardiovascular compromise, corticosteroid use was associated with a reduced in-hospital mortality (odds ratio: 0.47; 95% CI: 0.26–0.87), whereas among 5,803 children without cardiovascular compromise, it was not (odds ratio: 1.64; 95% CI: 0.99–2.74). Other subgroup analyses showed no significant differences between the groups. Conclusions Corticosteroid use did not significantly affect in-hospital mortality in children with severe CAP except in those with cardiovascular compromise. These findings suggest caution in the routine use of corticosteroids in this pediatric cohort, especially in those without cardiovascular compromise.