Open Access

ARTICLE

Glucocorticoid Therapy for Severe Infection in Children with Congenital Heart Disease: Effects on Immune Regulation and Clinical Outcomes

Jie Wu^1,#, Guiwen Liang^1,#, Ya Pan^1,#, Talaibaike Maimaijuma^2,3, Xianggui Xu^2,3, Juying Lu¹, Zhongwei Huang^1,*, Lei Qi^1,*, Haiyan Jiang^1,*

1 Department of Emergency Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
2 Department of Emergency Medicine, Kizilsu Kirghiz Autonomous Prefecture People’s Hospital, Kezhou, China
3 Department of Emergency Medicine, Affiliated Kezhou People’s Hospital of Nanjing Medical University, Kezhou, China

* Corresponding Authors: Zhongwei Huang. Email: ; Lei Qi. Email: ; Haiyan Jiang. Email:
# These authors contributed equally to this work

Structural and Congenital Heart Disease 2026, 21(2), 9 https://doi.org/10.32604/schd.2026.077080

Received 02 December 2025; Accepted 05 June 2026; Issue published 11 June 2026

Abstract

Background: Children with congenital heart disease (CHD) complicated by severe infection often present with immature immune function and poor prognosis. Evidence supporting the use of glucocorticoids in this population, particularly with dynamic immune monitoring, remains limited. Methods: A retrospective analysis was conducted on 183 CHD children with severe infections admitted to the Pediatric Intensive Care Unit (PICU) from 2019 to 2023. Patients were divided into two groups: the glucocorticoid intervention group (n = 92, methylprednisolone + standard treatment) and the control group (n = 91, standard treatment). Immune indicators (Interleukins-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), CD4⁺/CD8⁺ ratio at Day 0, 3, 7, and 14), clinical outcomes, and adverse events were compared using t-tests, Kaplan-Meier survival analysis, and Cox regression. Results: The glucocorticoid group exhibited a faster reduction in immune indicators (Day 7 IL-6: 62.9% vs. 29.2%; CD4⁺/CD8⁺ ratio: 0.93 vs. 0.79, p < 0.05). Additionally, the intervention group had shorter infection control times, ICU stays, and ventilation durations (all p < 0.001). A significant reduction in 28-day mortality was observed in the surgical subgroup (13.0% vs. 40.0%, p = 0.042; adjusted hazard ratio (aHR) = 0.44, p = 0.030), although the interaction between glucocorticoid use and surgical status was not statistically significant (p = 0.37). Higher rates of hyperglycemia (33.7% vs. 8.8%) and secondary infections (18.5% vs. 7.7%, p < 0.05) were observed, but these complications were manageable. Conclusions: Glucocorticoid therapy improves outcomes in CHD children with severe infections, with significant mortality reduction noted in the surgical subgroup. However, the lack of a statistically significant interaction with surgical status suggests that the benefits of glucocorticoids may not be exclusive to surgical patients.

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