Objective  To evaluate the effect of glucocorticoid (GC) treatment on the prognosis of patients with severe viral pneumonia, and to screen for related influencing factors and optimal beneficiary groups, providing reference for clinical medication decisions.

Methods  Based on the MIMIC-Ⅳ database, eligible patients with severe viral pneumonia were screened and divided into GC group and non GC group. Baseline differences were balanced using propensity score matching (PSM). Kaplan-Meier survival curves were used to analyze the cumulative survival rate of two groups of patients at 30 d, and Cox regression models were used to evaluate the association between GC use and the 30 d mortality risk in patients.

Results  A total of 518 severe viral pneumonia patients were included, including 43 in the GC group and 475 in the non-GC group. After PSM, there were 43 cases in the GC group and 86 cases in the non-GC group. The Kaplan-Meier survival curves showed that the 30 d cumulative survival rate of patients in the GC group was significantly higher than that in the non-GC group (P<0.05). The results of multivariate Cox regression analysis showed that GC treatment significantly reduced the 30 d mortality risk [HR=0.35, 95%CI (0.154, 0.793), P=0.012], especially for patients older than 54 years, receiving mechanical ventilation, and with acute kidney injury. GC use, age>54 years, and acute kidney injury were independent predictors of patient mortality risk (C-index=0.718 1). Subgroup analysis showed that for specific indications (age>54 years, mechanical ventilation, no myocardial infarction, no hypertension, no hyperlipidemia, no heart failure, complicated by acute kidney failure), GC use could effectively reduce the 30 d mortality risk.

Conclusion  GC could effectively improve the prognosis of severe viral pneumonia patients, but individualized patient characteristics and treatment risks need to be considered comprehensively to optimize the medication regimen.

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