Evidence map›Paper›PMID 37076606›Full record

SynthesisJournal of general internal medicine2023

Corticosteroids in Community-Acquired Bacterial Pneumonia: a Systematic Review, Pairwise and Dose-Response Meta-Analysis.

Tyler Pitre, Daniyal Abdali, Dipayan Chaudhuri, Stephen M Pastores, Andrea M Nei, Djillali Annane, Bram Rochwerg, Dena Zeraatkar

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 5 pooled it
16.9field-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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

26 citing papers in PubMed, 5 syntheses or guidelines pooled it, 79 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Trial
  7. Trial
  8. Trial
  9. Article
  10. Review
  11. Article
  12. Article
  13. Review
  14. Article
  15. Article
  16. Article
  17. Safety of steroids in severe community-acquired pneumonia.European respiratory review : an official journal of the European Respiratory Society · 2025
    Review
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 3 countries.

Tyler PitreDepartment of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.ORCID 0000-0003-3015-0723
Daniyal AbdaliDepartment of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Dipayan ChaudhuriDepartment of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Stephen M PastoresDepartment of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
Andrea M NeiDepartment of Pharmacy, Mayo Clinic Hospital, Rochester, Rochester, MN200 First St SW, Rochester, MN, 55905, USA.
Djillali AnnaneGeneral Intensive Care Unit, Raymond Poincaré hospital (APHP); Lab infection & inflammation U1173 School of medicine Simone Veil, University Paris Saclay, Paris, France.
Bram RochwergDepartment of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
Dena ZeraatkarDepartment of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada.
McMaster University · CAImpact · CAAssistance Publique – Hôpitaux de Paris · FRMayo Clinic · USMemorial Sloan Kettering Cancer Center · US

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Hongbiao Carl Lekaye · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

introductionInternational guidelines provide heterogenous guidance on use of corticosteroids for community-acquired pneumonia (CAP).

methodsWe performed a systematic review of randomized controlled trials examining corticosteroids in hospitalized adult patients with suspected or probable CAP. We performed a pairwise and dose-response meta-analysis using the restricted maximum likelihood (REML) heterogeneity estimator. We assessed the certainty of the evidence using GRADE methodology and the credibility of subgroups using the ICEMAN tool.

resultsWe identified 18 eligible studies that included 4661 patients. Corticosteroids probably reduce mortality in more severe CAP (RR 0.62 [95% CI 0.45 to 0.85]; moderate certainty) with possibly no effect in less severe CAP (RR 1.08 [95% CI 0.83 to 1.42]; low certainty). We found a non-linear dose-response relationship between corticosteroids and mortality, suggesting an optimal dose of approximately 6 mg of dexamethasone (or equivalent) for a duration of therapy of 7 days (RR 0.44 [95% 0.30 to 0.66]). Corticosteroids probably reduce the risk of requiring invasive mechanical ventilation (RR 0.56 [95% CI 0.42 to 74] and probably reduce intensive care unit (ICU) admission (RR 0.65 [95% CI 0.43 to 0.97]) (both moderate certainty). Corticosteroids may reduce the duration of hospitalization and ICU stay (both low certainty). Corticosteroids may increase the risk of hyperglycemia (RR 1.76 [95% CI 1.46 to 2.14]) (low certainty).

conclusionModerate certainty evidence indicates that corticosteroids reduce mortality in patients with more severe CAP, the need for invasive mechanical ventilation, and ICU admission.

Indexed as

Adrenal Cortex HormonesPneumonia, BacterialAdultHospitalizationHumansIntensive Care UnitsRespiration, ArtificialAdrenal Cortex Hormones

Identifiers

PMID37076606
PMCPMC10115386
OpenAlexW4366462833

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.