Dose-response relationship of pre-ICU corticosteroids and influenza-associated pulmonary aspergillosis: a multicenter target trial emulation
Main finding · IAPAResult — go to the resultWeighted hazard ratio 2.11 95% CI 1.25–3.56Authors' conclusion
Pre-ICU corticosteroid exposure is associated with a nonlinear, dose-dependent increase in IAPA risk.
Study context
- Population
- Critically ill, non-neutropenic adults with influenza, 48 ICUs in Central China (January 2023-June 2025)74.2% exposed
- Participants
- 2,763 participants
- Exposure
- Pre-ICU corticosteroid exposure vs no exposure; dose-response
- Outcome
- Influenza-associated pulmonary aspergillosis (IAPA) during ICU stay
Methodological detailsmulticentre observational cohort study, inverse probability of treatment weighting, restricted cubic splines, segmented regression
- Multicentre observational cohort study
- Inverse probability of treatment weighting
- Restricted cubic splines
- Segmented regression
Main finding
IAPA · during ICU stay
Weighted hazard ratio
2.11
95% CI 1.25–3.56
Exposed vs Unexposed
weighted HR 2.11 (95% CI 1.25–3.56)
As reported in the abstract
- Influenza-associated pulmonary aspergillosis (IAPA) incidence, all patients
- 191 (6.9%)
- Non-linear, J-shaped dose-response relationship
- P < 0.001
- Dose for 50% risk increase
- 43.4 mg
- Dose for doubling of risk
- 51.4 mg
- Steep inflection point
- 63.7 mg (95% CI 62.8-64.7)
Observational data: associations, not effects.
Further findings
Effect modification by SOFA score (>7) (subgroup)
- Higher SOFA scores (>7) significantly amplified per-dose risk
- P < 0.001
- Threshold for 50% increase, SOFA >7
- 35.2 mg
- Threshold for doubling, SOFA >7
- 39.5 mg
Original publication
Dose-response relationship of pre-ICU corticosteroids and influenza-associated pulmonary aspergillosis: a multicenter target trial emulation. Ann Intensive Care. Published 3 August 2026. doi:10.
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