Evidence map›Paper›PMID 42604214›Full record

ArticleAnnals of intensive care2026

Dose-response relationship of pre-ICU corticosteroids and influenza-associated pulmonary aspergillosis: a multicenter target trial emulation.

Shengnan Xu, Hongmei Liu, Pengli Fan, Hao Dou, Leilei Guo, Bo Qiao, Yuanyuan Li, Yansheng Zhou, Xiufeng Hu, Yanyan Guo and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of intensive care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
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

2 citing papers in PubMed.

  1. Article
  2. 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

16 authors.

Shengnan XuRespiratory Intensive Care Unit, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Hongmei LiuRespiratory Intensive Care Unit, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Pengli FanDepartment of Pharmacy, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Hao DouDepartment of Respiratory and Critical Care Medicine, Pulmonary Endoscopy Center, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Leilei GuoInfection Prevention and Control Department, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
Bo QiaoInfection Prevention and Control Department, Henan Provincial Chest Hospital, Zhengzhou, China.
Yuanyuan LiInfection Prevention and Control Department, The First Affiliated Hospital of Nanyang Medical College, Nanyang, China.
Yansheng ZhouInfection Prevention and Control Department, The First Affiliated Hospital of Henan Medical University, Xinxiang, China.
Xiufeng HuInfection Prevention and Control Department, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
Yanyan GuoInfection Prevention and Control Department, Huaihe Hospital of Henan University, Kaifeng, China.
Bin HuInfection Prevention and Control Department, Zhumadian Central Hospital, Zhumadian, China.
Sangang ZhengInfection Prevention and Control Department, Jiyuan People's Hospital, Jiyuan, China.
Junping LiuDepartment of Infectious Disease, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Jiangfeng ZhangDepartment of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
Junzhe BaoCollege of Public Health, Zhengzhou University, Zhengzhou, China.
Peng LiDepartment of Infection Control, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Prior corticosteroid use is linked to influenza-associated pulmonary aspergillosis (IAPA) in critically ill patients, yet the dose-response relationship remains unclear. Methods: In this multicenter emulated target trial across 48 ICUs in Central China (January 2023-June 2025), we included critically ill, non-neutropenic adults with influenza. Using inverse probability of treatment weighting (IPTW) and restricted cubic splines, we modeled the dose-response association between pre-ICU corticosteroid exposure and IAPA, identifying risk thresholds via segmented regression. Effect modification by pre-specified patient characteristics was further assessed. Results: Among 2763 patients (74.2% exposed to corticosteroids; median dose 35 mg dexamethasone-equivalent), 191 (6.9%) developed IAPA during their ICU stay. Pre-ICU corticosteroid exposure was independently associated with IAPA (weighted HR = 2.11; 95% CI 1.25-3.56). A non-linear, J-shaped dose-response relationship was identified (P < 0.001). Risk increased continuously, with a 50% increase at 43.4 mg and doubling at 51.4 mg, followed by a steep inflection point at 63.7 mg (95% CI 62.8-64.7). Higher SOFA scores (>7) significantly amplified per-dose risk (P < 0.001), lowering thresholds to 35.2 mg for 50% increase and 39.5 mg for doubling. Conclusions: Pre-ICU corticosteroid exposure is associated with a nonlinear, dose-dependent increase in IAPA risk. Cumulative doses approaching 40-50 mg warrant heightened vigilance, particularly in severely ill patients. These findings support individualized, dose-aware corticosteroid stewardship in severe influenza.

Indexed as

CorticosteroidDirected acyclic graphsDose-responseInfluenza-associated pulmonary aspergillosisTarget trial emulation

Identifiers

PMID42604214
PMCPMC13476715

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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.