Evidence map›Paper›PMID 26508525›Full record

SynthesisIntensive care medicine2016

Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients' data from four randomized trials and trial-level meta-analysis of the updated literature.

G Umberto Meduri, Lisa Bridges, Mei-Chiung Shih, Paul E Marik, Reed A C Siemieniuk, Mehmet Kocak

Registry-linked trialAbstract readMeta-AnalysisReview
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05062681 (Randomized Controlled Trial on the Efficacy of Dexamethasone Versus Methyl Prednisolone in Covid-19 Infected Patients With High Oxygen Flow), which is not on this map. Cited by 132 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
132citing papers in PubMed, 7 pooled it
14.1field-weighted citation impact, top 1% of its field
1 · What the graph read from 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.

2 · The registry

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.

NCT05062681 phase4unknown statusnot on this mapstarted 2021, after this paper: background citation

Randomized Controlled Trial on the Efficacy of Dexamethasone Versus Methyl Prednisolone in Covid-19 Infected Patients With High Oxygen Flow

TypeinterventionalSponsorCairo UniversityRan2021 to 2022Enrolled60ConditionsCOVID-19 PandemicArmsDexamethasone, Methylprednisolone
3 · Its place in the literature

Who cites it

132 citing papers in PubMed, 7 syntheses or guidelines pooled it, 261 citations in OpenAlex.

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  18. [Acute respiratory distress syndrome : Pathophysiology, definition and treatment strategies].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025
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72 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 2 countries.

G Umberto MeduriDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Memphis Veterans Affairs Medical Center (111), 1030 Jefferson Avenue, Suite Room #CW444, Memphis, TN, 38104, USA. gmeduri@uthsc.edu.
Lisa BridgesDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Memphis Veterans Affairs Medical Center (111), 1030 Jefferson Avenue, Suite Room #CW444, Memphis, TN, 38104, USA.
Mei-Chiung ShihDepartment of Veterans Affairs, Cooperative Studies Program Coordinating Center, Palo Alto, CA, USA.
Paul E MarikDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
Reed A C SiemieniukDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Mehmet KocakDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Eastern Virginia Medical School · USMcMaster University · CAStanford University · USUniversity of Tennessee Health Science Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo investigate the effect of prolonged glucocorticoid treatment for patients with acute respiratory distress syndrome (ARDS).

methodsWe conducted two sets of intention-to-treat analyses: (1) a primary analysis of individual patients' data (IPD) of four randomized controlled trials (RCTs) which investigated methylprednisolone treatment (n = 322) and (2) a trial-level meta-analysis incorporating four additional RCTs which investigated hydrocortisone treatment in early ARDS (n = 297). We standardized definitions to derive outcomes in all datasets. The primary outcome for the IPD analysis was time to achieving unassisted breathing (UAB) by study day 28. Secondary outcomes included mechanical ventilation (MV) and intensive care unit (ICU)-free days, hospital mortality, and time to hospital mortality by day 28.

resultsBy study day 28, compared to the placebo group, the methylprednisolone group had fewer patients who died before achieving UAB (12 vs. 29 %; p < 0.001) and more patients who achieved UAB (80 vs. 50 %; p < 0.001). In the methylprednisolone group, time to achieving UAB was shorter [hazard ratio 2.59, 95 % confidence interval (CI) 1.95-3.43; p < 0.001], and hospital mortality was decreased (20 vs. 33 %; p = 0.006), leading to increased MV (13.3 ± 11.8 vs. 7.6 ± 5.7; p < 0.001) and ICU-free days (10.8 ± 0.71 vs. 6.4 ± 0.85; p < 0.001). In those patients randomized before day 14 of ARDS onset, the trial-level meta-analysis indicated decreased hospital mortality (36 vs. 49 %; risk ratio 0.76, 95 % CI 0.59-0.98, I (2) = 17 %, p = 0.035; moderate certainty). Treatment was not associated with increased risk for infections (risk ratio 0.77, 95 % CI 0.56-1.08, I (2) = 26 %; p = 0.13; moderate certainty).

conclusionsProlonged methylprednisolone treatment accelerates the resolution of ARDS, improving a broad spectrum of interrelated clinical outcomes and decreasing hospital mortality and healthcare utilization.

Indexed as

GlucocorticoidsHospital MortalityHumansIntensive Care UnitsMethylprednisoloneRandomized Controlled Trials as TopicRespiration, ArtificialRespiratory Distress SyndromeGlucocorticoidsMethylprednisoloneAdult respiratory distress syndromeGlucocorticoid treatmentMechanical ventilationSurvival

Identifiers

PMID26508525
OpenAlexW1862839341

What OpenQuestion holds

Textmetadata
Read underepoch 390

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.