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May 14, 2025 🔬 Who benefits from corticosteroids in hospitalized patients with Community-Acquired Pneumonia (CAP)? In our recent study published in Lancet Respiratory Medicine, we used data-driven analysis of 8 randomized trials to answer this question.

🔑 Key Takeaways:

  • 📈 30-day survival benefits were tied to high baseline CRP levels (>204 mg/L).
  • ⚠️ Patients with lower CRP saw no mortality benefit from corticosteroids.
We further clarify our findings in a newly published correspondence. Here’s what we addressed:

🔹 Multicollinearity?

Low Variance Inflation Factors suggest CRP is not just a stand-in for other observed variables.

🔹 Secondary Outcomes?

90-day survival and intubation rates also trended toward greater benefit with high CRP.

🔹 Benefit vs. Harm?

There’s a clear trade-off — higher rates of hyperglycemia and readmissions in steroid-treated patients highlight the need for careful clinical judgment.

🔹 CRP Only?

While other markers (like cytokines) may help in the future, our multivariate analysis supported CRP as the sole predictor of benefit.

🔹 Severe CAP?

Despite SCCM guideline support for corticosteroids in severe CAP, no greater benefit was found in severe vs. non-severe CAP — regardless of severity definition (PSI, CURB-65, ICU/IMV).

🔹 Viral CAP?

Among the 11% of viral cases (including 6% influenza), corticosteroids showed a non-significant trend toward harm — even at high CRP. This calls for caution and further research.

✅ Conclusion

CRP is a widely available, routinely measured, and now evidence-supported tool to guide corticosteroid therapy in CAP patients.
Jan 29, 2025 📢 New Publication! 📢

Our data-driven analysis of randomised trials to predict benefit from corticosteroids in hopitalised Community-Acquired-Pneumonia (CAP) is now available in the latest issue of Lancet Respiratory Medicine

Here are the key take-aways:

💡 The Controversy:
  • Routine corticosteroid use for CAP is debated, with conflicting recommendations in recent SCCM and ERS / ESICM ESCMID / ALAT guidelines.
  • While some guidelines suggest corticosteroids for severe CAP, evidence remains insufficient and the definition of “severe” inconsistent
🔍 What We Did:
  • Conducted an individual patient data meta-analysis, covering 8 RCTs and 3,248 patients hospitalised with CAP.
  • Focused on analysing heterogeneity of treatment effects (HTE) using data-driven approaches
  • We developed and externally validated a novel corticosteroid-effect model, pinpointing baseline C-reactive protein (CRP) as a critical predictor for benefit
📊 Key Findings:
  • We found significant overall mortality reduction from corticosteroids in hospitalized CAP, but ...
  • Survival benefits were tied to high baseline CRP concentrations (>204 mg/L), while patients with lower CRP concentrations showed no mortality benefit.
  • Contrary to earlier assumptions, we found no significant HTE between less severe vs severe CAP (PSI class I–III vs IV–V).
  • Trade-offs: Overall increased hospital re-admissions and hyperglycaemia incidence due to corticosteroid use.
🧠 Implications for Practice:
  • Current guidelines overlook CRP levels in corticosteroid treatment decisions.h
  • Our study paves the way for more targeted corticosteroid therapy in CAP, through threshold-based CRP guidance
✨✨✨ Proud of our team of authors, including contributors from seven countries, over ten cities, and a diverse range of both clinical and technical expertise:
Jan 26, 2025 📢 New Preprint on medrXiv! 📢

On the Heterogeneous Treatnent Effect of higher vs lower PEEP strategies in ARDS.