SynthesisCritical care (London, England)2014
Exploring the heterogeneity of effects of corticosteroids on acute respiratory distress syndrome: a systematic review and meta-analysis.
Synthesis in Critical care (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 77 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
77 citing papers in PubMed, 8 syntheses or guidelines pooled it, 148 citations in OpenAlex.
- Identifying effect modifiers of corticosteroids in acute respiratory distress syndrome: a meta-regression analysis of randomized controlled trials.BMC pulmonary medicine · 2026Pooled it
- Efficacy of corticosteroids in patients with acute respiratory distress syndrome: a meta-analysis.Annals of medicine · 2024Pooled it
- Predictive value of computed tomography for short-term mortality in patients with acute respiratory distress syndrome: a systematic review.Scientific reports · 2022Pooled it
- Pooled it
- Efficacy and Safety of Corticosteroid Treatment in Patients With COVID-19: A Systematic Review and Meta-Analysis.Frontiers in pharmacology · 2020Pooled it
- Guidelines on the management of acute respiratory distress syndrome.BMJ open respiratory research · 2019Guideline
- Corticosteroids for pneumonia.The Cochrane database of systematic reviews · 2017Pooled it
- Scandinavian clinical practice guideline on fluid and drug therapy in adults with acute respiratory distress syndrome.Acta anaesthesiologica Scandinavica · 2016Guideline
- Polymorphism in interferon alpha/beta receptor contributes to glucocorticoid response and outcome of ARDS and COVID-19.Critical care (London, England) · 2023Trial
- The effectiveness of Corticosteroids on mortality in patients with acute respiratory distress syndrome or acute lung injury: a secondary analysis.Scientific reports · 2015Trial
- ARDS and corticosteroids: beyond COVID-19.Pneumonia (Nathan Qld.) · 2026Review
- Time-varying associations between corticosteroid dose and hospital mortality in ARDS: a sliding-window analysis of MIMIC-IV.BMC pulmonary medicine · 2026Observational
- The metabolic response to stress in critical illness: updated review on the pathophysiological mechanisms, consequences, and therapeutic implications.Annals of intensive care · 2025Review
- Immunomodulatory therapies in community-acquired pneumonia: a protocol for a systematic review and network meta-analysis.BMJ open · 2025Article
- Glucocorticoid therapy for acute respiratory distress syndrome: Current concepts.Journal of intensive medicine · 2024Review
- A High-Dose Corticosteroid Treatment Increases Coronavirus Disease of 2019 Mortality in Intensive Care Units.Turkish journal of pharmaceutical sciences · 2024Article
- Corticosteroids in adults with acute respiratory distress syndrome and severe pneumonia.BJA education · 2023Review
- Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter-A Critical Review and Viewpoints.Pharmaceuticals (Basel, Switzerland) · 2023Review
- Genetic Determinants of the Acute Respiratory Distress Syndrome.Journal of clinical medicine · 2023Review
- Corticosteroids treatment for pediatric acute respiratory syndrome: A critical review.Saudi medical journal · 2023Review
17 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe effectiveness of corticosteroid therapy on the mortality of acute respiratory distress syndrome (ARDS) remains under debate. We aimed to explore the grounds for the inconsistent results in previous studies and update the evidence.
methodsWe searched MEDLINE, Cochrane Central Register of Controlled Trials and Web of Science up to December 2013. Eligible studies included randomized clinical trials (RCTs) and cohort studies that reported mortality and that had corticosteroid nonusers for comparison. The effect of corticosteroids on ARDS mortality was assessed by relative risk (RR) and risk difference (RD) for ICU, hospital, and 60-day mortality using a random-effects model.
resultsEight RCTs and 10 cohort studies were included for analysis. In RCTs, corticosteroids had a possible but statistically insignificant effect on ICU mortality (RD, -0.28; 95% confidence interval (CI), -0.53 to -0.03 and RR, 0.55; 95% CI, 0.24 to 1.25) but no effect on 60-day mortality (RD, -0.01; 95% CI, -0.12 to 0.10 and RR, 0.97; 95% CI, 0.75 to 1.26). In cohort studies, corticosteroids had no effect on ICU mortality (RR, 1.05; 95% CI, 0.74 to 1.49) but non-significantly increased 60-day mortality (RR, 1.30; 95% CI, 0.96 to 1.78). In the subgroup analysis by ARDS etiology, corticosteroids significantly increased mortality in influenza-related ARDS (three cohort studies, RR, 2.45, 95% CI, 1.40 to 4.27).
conclusionsThe effects of corticosteroids on the mortality of ARDS differed by duration of outcome measures and etiologies. Corticosteroids did not improve longer-term outcomes and may cause harm in certain subgroups. Current data do not support routine use of corticosteroids in ARDS. More clinical trials are needed to specify the favorable and unfavorable subgroups for corticosteroid therapy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.