Effects of adjunctive corticosteroids therapy in Non-HIV Pneumocystis jirovecii pneumonia: a real-world multicenter cohort study

Pneumocystis jirovecii pneumonia (PJP) constitutes a significant clinical burden even in patients without HIV infection, but the role of corticosteroids in such population remained controversial. The multicenter retrospective study aimed to evaluate the impact of adjunctive corticosteroids on outcomes in non-HIV patients with PJP. The primary outcome was all-cause mortality at 60 days. Among 334 enrolled subjects, 251 (75.1%) received adjunctive corticosteroids. Kaplan-Meier analysis showed higher 60-days mortality rate in patients with adjunctive corticosteroids (log-rank P < 0.001). However, corticosteroid-treated patients showed more shock (43.0% vs. 25.3%; P = 0.002) and worse PaO2/FiO2 (183.3 vs. 290.3; P < 0.001). By multivariable and 1:1 propensity score matching analysis, adjunctive corticosteroid therapy was not associated with higher mortality (log-rank P = 0.13). Subgroup analyses were conducted to explore potential effect modifiers. Among the subgroup of patients without shock, we found adjunctive corticosteroids were associated with higher mortality (odds ratio 2.72, 95% confidence interval 1.11-6.66; P = 0.03). The observed association between adjunctive corticosteroids and higher 60-day mortality in non-HIV PJP might primarily relate to underlying indications for corticosteroid use rather than direct therapeutic effects. Adjunctive steroid used in patients with low disease severity should therefore be reconsidered.