[Clinical Study of Different Doses of Glucocorticoids in the Treatment of Severe

Objective: To analyze the clinical characteristics of children with severe Methods: Clinical data from 271 children who were hospitalized at Tianjin Children's Hospital between January 1, 2021 and December 31, 2022, and who received GC treatment for SMPP were retrospectively collected. The patients were divided into low-dose (methylprednisolone ≤ 2 mg/[kg·d]) and high-dose (methylprednisolone > 2 mg/[kg·d]) groups. A 1∶1 PSM based on the matching variables, including time from onset to admission, time from fever onset to GC administration, and time from GC administration to follow-up chest X-ray, was performed to reduce confounding factors, resulting in 90 matched pairs in total in the low-dose and high-dose groups. Clinical characteristics were compared between the two groups after PSM. Multivariate logistic regression was performed to identify risk factors for high-dose GC use. The 90 pairs of children were further divided into an ineffective group ( Results: Children in the high-dose group were younger and had higher platelet counts and a higher incidence of atelectasis (all Conclusion: High-dose GC therapy may facilitate fever resolution, shorten the duration of fever, and enhance radiological improvement. However, its overall efficacy is not significantly superior to low-dose therapy and is associated with a higher incidence of adverse reactions. Younger age, atelectasis, and elevated platelet count are key factors influencing the use of high-dose GC in children. Notably, RMPP and high peak fever are independent risk factors for GC treatment failure, irrespective of the GC dosage. Clinicians should carefully evaluate the individualized risk-benefit profile when considering high-dose GC therapy for pediatric SMPP.