Comments on “Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials”
Abstract
Heterogeneity among different studies The authors pooled results from seven studies from 1993 to 2023 and used the I2 statistic to assess the heterogeneity. The authors reached the conclusion that “low heterogeneity in most outcomes” was observed based on low I2 estimates. However, tests for heterogeneity using the I2 statistic is often underpowered, especially with a small number of included study; it is thus insufficient to conclude that the studies have low heterogeneity based on the I2 statistic alone. In addition, a close examination of the seven included studies would reveal several potentially important sources of heterogeneity. First, the definition of comparison for each randomized controlled trial (RCT) is different as the standard of care has changed significantly over the past 30 years. The increasing prevalence of antimicrobial resistance leading to varying choices of antibiotics, adoption of high flow nasal cannulation, and changing ventilation strategies are some examples [2–4]. Second, different regimens of corticosteroids were administered in each RCT, which should result in significant variability among the studies included. Third, different patient populations were included in each RCT. For example, Torres et al.’s study focused only on patients with C-reactive protein (CRP) > 150 mg/L at admission while other studies did not exclude patients based on their CRP levels [5]. The pooled estimates should thus be interpreted with caution and consideration for…
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