| 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: |