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Background <p>The use of corticosteroids in the treatment of influenza-associated pneumonia remains highly controversial due to their dual role in mitigating cytokine storms while potentially increasing the risk of secondary infections and delaying viral clearance. Consequently, this research was designed to investigate the prognostic implications of utilizing adjunctive corticosteroids in the therapeutic management of patients with influenza pneumonia.</p> Methods <p>In this retrospective cohort study, the medical records of 134 adults with PCR-confirmed influenza-associated pneumonia admitted to Shahid Beheshti Hospital, Kashan, Iran, between 2020 and 2024 were reviewed. Patients were classified according to systemic corticosteroid exposure during hospitalization: standard therapy without systemic corticosteroids (<i>n</i> = 45) and standard therapy plus systemic corticosteroids (<i>n</i> = 89). The outcomes included ICU admission, intubation, in-hospital mortality, and length of hospital stay. To reduce measured baseline differences between the treatment groups, 1:1 propensity score matching without replacement was performed using age, sex, hypertension, diabetes mellitus, kidney disease, dyspnea, tachypnea, altered consciousness, and admission systolic blood pressure, heart rate, body temperature, and oxygen saturation. Binary outcomes were analyzed using conditional logistic regression stratified by matched pair.</p> Results <p>Propensity score matching generated 40 matched pairs. In the matched cohort, ICU admission occurred in 5 patients (12.5%) receiving corticosteroids and 4 patients (10.0%) receiving standard therapy (matched OR, 1.25; 95% CI, 0.34–4.66; <i>p</i> = 0.739). Intubation was required in 5 patients (12.5%) and 4 patients (10.0%), respectively (matched OR, 1.25; 95% CI, 0.34–4.66; <i>p</i> = 0.739). In-hospital mortality occurred in 2 patients (5.0%) in the corticosteroid group and 4 patients (10.0%) in the standard-therapy group; however, the association was not statistically significant and was imprecisely estimated (matched OR, 0.50; 95% CI, 0.09–2.73; <i>p</i> = 0.423).</p> Conclusion <p>After propensity score matching, adjunctive corticosteroid use was not significantly associated with ICU admission, intubation, or in-hospital mortality. However, the confidence intervals were wide, particularly for mortality, and residual confounding by indication could not be excluded. These findings should therefore be interpreted as observational associations rather than evidence of a causal treatment effect.</p>

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The effect of adjunctive corticosteroids on the clinical outcomes of influenza-associated pneumonia: a retrospective cohort study

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  • 发表日期：

    2026年7月31日

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  • Majid Madihi,
  • Alireza Sharif,
  • Mohammad Javad Azadchehr,
  • Leila Erfanirad,
  • Maedeh Najafizadeh

摘要

Background

The use of corticosteroids in the treatment of influenza-associated pneumonia remains highly controversial due to their dual role in mitigating cytokine storms while potentially increasing the risk of secondary infections and delaying viral clearance. Consequently, this research was designed to investigate the prognostic implications of utilizing adjunctive corticosteroids in the therapeutic management of patients with influenza pneumonia.

Methods

In this retrospective cohort study, the medical records of 134 adults with PCR-confirmed influenza-associated pneumonia admitted to Shahid Beheshti Hospital, Kashan, Iran, between 2020 and 2024 were reviewed. Patients were classified according to systemic corticosteroid exposure during hospitalization: standard therapy without systemic corticosteroids (n = 45) and standard therapy plus systemic corticosteroids (n = 89). The outcomes included ICU admission, intubation, in-hospital mortality, and length of hospital stay. To reduce measured baseline differences between the treatment groups, 1:1 propensity score matching without replacement was performed using age, sex, hypertension, diabetes mellitus, kidney disease, dyspnea, tachypnea, altered consciousness, and admission systolic blood pressure, heart rate, body temperature, and oxygen saturation. Binary outcomes were analyzed using conditional logistic regression stratified by matched pair.

Results

Propensity score matching generated 40 matched pairs. In the matched cohort, ICU admission occurred in 5 patients (12.5%) receiving corticosteroids and 4 patients (10.0%) receiving standard therapy (matched OR, 1.25; 95% CI, 0.34–4.66; p = 0.739). Intubation was required in 5 patients (12.5%) and 4 patients (10.0%), respectively (matched OR, 1.25; 95% CI, 0.34–4.66; p = 0.739). In-hospital mortality occurred in 2 patients (5.0%) in the corticosteroid group and 4 patients (10.0%) in the standard-therapy group; however, the association was not statistically significant and was imprecisely estimated (matched OR, 0.50; 95% CI, 0.09–2.73; p = 0.423).

Conclusion

After propensity score matching, adjunctive corticosteroid use was not significantly associated with ICU admission, intubation, or in-hospital mortality. However, the confidence intervals were wide, particularly for mortality, and residual confounding by indication could not be excluded. These findings should therefore be interpreted as observational associations rather than evidence of a causal treatment effect.