SynthesisCritical care (London, England)2026
Efficacy of higher-dose versus lower-dose corticosteroids in community-acquired pneumonia: a systematic review and network meta-analysis.
Synthesis in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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12 authors.
Funding
Abstract
backgroundAdjunctive corticosteroids improve outcomes in hospitalized patients with community-acquired pneumonia (CAP), but whether higher-dose regimens provide additional benefit over lower-dose regimens remains uncertain.
methodsWe searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) up to January 25, 2026. Interventions were standardized to protocol-assigned dexamethasone-equivalent doses: high (≥ 7.5 mg/d) and low (< 7.5 mg/d). A frequentist network meta-analysis was performed. The primary outcome was short-term all-cause mortality. Confidence in network meta-analysis estimates was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework.
results32 RCTs involving 9,746 participants were included. Compared with placebo or usual care, higher-dose corticosteroids were associated with lower short-term mortality (Risk Ratio [RR], 0.83; 95% Confidence Interval [CI], 0.74-0.92), as were lower-dose corticosteroids (RR, 0.84; 95% CI, 0.75-0.95). The indirect comparison showed no clear difference between higher- and lower-dose regimens (RR, 0.98; 95% CI, 0.83-1.16). In severe patients with CAP, the corresponding indirect estimate was RR 1.01 (95% CI, 0.77-1.33). Most secondary active-dose comparisons were imprecise and showed no consistent advantage of either strategy.
conclusionCompared with placebo or usual care, lower-dose corticosteroids (moderate confidence) and higher-dose corticosteroids (low confidence) were both associated with lower short-term mortality. The indirect higher-versus-lower dose comparison showed no clear mortality difference between dose categories; confidence in this comparison was low. Future research should prioritize large, head-to-head RCTs designed to evaluate whether selected inflammatory phenotypes benefit from higher-dose corticosteroids.
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